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爱尔兰全科医疗记录的回顾性分析:2 型糖尿病患者血糖控制不佳和蛋白尿的决定因素。

Determinants of poor glycaemic control and proteinuria in patients with type 2 diabetes: a retrospective analysis of general practice records in Ireland.

机构信息

School of Medicine, University of Limerick, Limerick, Ireland.

Health Research Institute, University of Limerick, Limerick, Ireland.

出版信息

BMC Prim Care. 2024 Jan 10;25(1):22. doi: 10.1186/s12875-023-02252-w.


DOI:10.1186/s12875-023-02252-w
PMID:38200427
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10777496/
Abstract

BACKGROUND: Analysis of general practice records can address the information gap on the epidemiology of type 2 diabetes (T2DM) in Ireland, informing practice and the development of interventions in primary care. The aim of this study was to identify patients with poor glycaemic control, risk factors for complications and evidence of end organ damage in a large multi-practice study and to profile their characteristics. METHODS: Patients with T2DM were identified using disease coding in Health One practice management software in 41 general practices. Patients' demographics and clinical data were extracted. Rates of poor glycaemic control (glycated haemoglobin > 58 mmol/mol) and albumin creatinine ratio > 3 mg/mmol were calculated. A multilevel logistic regression analysis using both patient and practice variables was conducted. RESULTS: Data was collected from 3188 patients of whom 29% (95% CI 28 to 31%) had poor glycaemic control, which was associated with younger age, higher BMI and higher total cholesterol. Only 42% of patients (n = 1332) had albumin creatinine ratio measured with 42% (95% CI 40 to 45%) of these having values > 3 mg/mmol. Older age groups, men, those with hypertension, eGFR < 60 ml/min/1.73m and poor glycaemic control were most associated with higher values of albumin creatinine ratio. CONCLUSIONS: Analysing this large multi-practice dataset gives important information on the prevalence and characteristics of diabetic patients who are most at risk of poor outcomes. It highlights that recording of some data could be improved.

摘要

背景:分析全科医疗记录可以解决爱尔兰 2 型糖尿病(T2DM)流行病学信息空白问题,为基层医疗实践和干预措施的制定提供信息。本研究旨在确定大型多实践研究中血糖控制不佳、并发症风险因素和终末器官损伤证据的患者,并分析其特征。

方法:在 41 家全科诊所的 Health One 诊所管理软件中使用疾病编码识别 T2DM 患者。提取患者的人口统计学和临床数据。计算血糖控制不佳(糖化血红蛋白>58mmol/mol)和白蛋白肌酐比值>3mg/mmol的发生率。使用患者和诊所变量进行多级逻辑回归分析。

结果:共收集了 3188 名患者的数据,其中 29%(95%置信区间 28-31%)血糖控制不佳,与年龄较小、BMI 较高和总胆固醇较高有关。只有 42%(n=1332)的患者测量了白蛋白肌酐比值,其中 42%(95%置信区间 40-45%)>3mg/mmol。年龄较大、男性、高血压、eGFR<60ml/min/1.73m 和血糖控制不佳的患者与白蛋白肌酐比值较高最相关。

结论:分析这个大型多实践数据集为处于不良预后风险最高的糖尿病患者的流行情况和特征提供了重要信息。它强调了一些数据的记录可以得到改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f675/10777496/be7c8a6d1068/12875_2023_2252_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f675/10777496/41d2fa6b9701/12875_2023_2252_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f675/10777496/be7c8a6d1068/12875_2023_2252_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f675/10777496/41d2fa6b9701/12875_2023_2252_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f675/10777496/be7c8a6d1068/12875_2023_2252_Fig2_HTML.jpg

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Determinants of poor glycaemic control and proteinuria in patients with type 2 diabetes: a retrospective analysis of general practice records in Ireland.

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本文引用的文献

[1]
Can we cure diabetic kidney disease? Present and future perspectives from a nephrologist's point of view.

J Intern Med. 2022-2

[2]
Risk of Typical Diabetes-Associated Complications in Different Clusters of Diabetic Patients: Analysis of Nine Risk Factors.

J Pers Med. 2021-4-22

[3]
Sex-Related Disparities in the Incidence and Outcomes of Ischemic Stroke among Type 2 Diabetes Patients. A Matched-Pair Analysis Using the Spanish National Hospital Discharge Database for Years 2016-2018.

Int J Environ Res Public Health. 2021-4-1

[4]
Are there sex differences in the effect of type 2 diabetes in the incidence and outcomes of myocardial infarction? A matched-pair analysis using hospital discharge data.

Cardiovasc Diabetol. 2021-4-22

[5]
Association of Lipid Profile with Type 2 Diabetes in First-Degree Relatives: A 14-Year Follow-Up Study in Iran.

Diabetes Metab Syndr Obes. 2020-8-5

[6]
High ACR level is a strong risk factor for renal tubular impairment in patients with type 2 diabetes: A longitudinal observational study.

Diabetes Res Clin Pract. 2020-6-16

[7]
The effect of 'paying for performance' on the management of type 2 diabetes mellitus: a cross-sectional observational study.

BJGP Open. 2020-6-23

[8]
2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk.

Eur Heart J. 2020-1-1

[9]
Smoking in men and women with type 2 diabetes: A qualitative gender-sensitive exploration of barriers to smoking cessation among people with type 2 diabetes.

PLoS One. 2019-8-28

[10]
Real-world evidence of glycemic control among patients with type 2 diabetes mellitus in India: the TIGHT study.

BMJ Open Diabetes Res Care. 2019-7-14

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