Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Med Sci. 2023 May;48(3):286-291. doi: 10.30476/ijms.2022.92805.2409.
Clinical guidelines and expert committees have recently suggested that the hemoglobin A1C (HbA1c) should be individualized based on various criteria. Data regarding the achievement of individualized glycemic targets in type 2 diabetes mellitus (T2DM) patients is scant in Iran. We intended to provide information found on real-world outcomes from the perspective of an individualized recommendation.
A cross-sectional analysis was conducted in 15 diabetes centers in Iran between 2013-2017. Two steps cluster sampling selection was used to recruit 1591 patients with T2DM. Considering Ismail-Beigi's individualized strategy, the study population was categorized into five treatment intensities of HbA1c: most intensive (≤6.5%), intensive (6.5-7.0%), less intensive (7.0%), not intensive (7.0-8.0%), and moderated (8.0%). The percentage of patients who met their group individualized glycemic targets was estimated as the degree of achievement of each treatment intensity.
The cumulative incidence rate of early microvascular, advanced microvascular, and macrovascular complications was 53%, 25%, and 34%, respectively. Besides, [78% 77.6-79%] of patients did not achieve individualized glycemic targets.
The outcome showed poor individualized glycemic control and a high incidence of diabetes complications. Considering individualized HbA1c targets for Iranian patients with T2DM is an urgent need.
临床指南和专家委员会最近建议根据各种标准将糖化血红蛋白（HbA1c）个体化。关于 2 型糖尿病（T2DM）患者实现个体化血糖目标的数据在伊朗很少。我们旨在从个体化推荐的角度提供真实世界结果的数据。
2013 年至 2017 年，在伊朗的 15 个糖尿病中心进行了横断面分析。采用两步聚类抽样选择方法招募了 1591 名 T2DM 患者。考虑到 Ismail-Beigi 的个体化策略，将研究人群分为 HbA1c 的五种治疗强度：最强化（≤6.5%）、强化（6.5-7.0%）、弱化（7.0%）、非强化（7.0-8.0%）和适度强化（8.0%）。估计每组患者达到其个体化血糖目标的百分比作为每种治疗强度的达标程度。
早期微血管、晚期微血管和大血管并发症的累积发生率分别为 53%、25%和 34%。此外，[78%（77.6%-79%）]的患者未达到个体化血糖目标。
结果显示个体化血糖控制不佳且糖尿病并发症发生率较高。考虑到伊朗 T2DM 患者的个体化 HbA1c 目标是当务之急。
