Louie Judy Z, Shiffman Dov, Rowland Charles M, Kenyon Norma S, Bernal-Mizrachi Ernesto, McPhaul Michael J, Garg Rajesh
Quest Diagnostics Nichols Institute, 33608 Ortega Highway, San Juan Capistrano, CA, 92675, USA.
Diabetes Research Institute, Miller School of Medicine, 1951 NW 7Th Avenue, Miami, FL, 33136, USA.
Clin Diabetes Endocrinol. 2024 Jan 25;10(1):2. doi: 10.1186/s40842-023-00160-7.
Professional guidelines recommend an HbA1c < 7% for most people with diabetes and < 8.5% for those with relaxed glycemic goals. However, many people with type 2 diabetes mellitus (T2DM) are unable to achieve the desired HbA1c goal. This study evaluated factors associated with lack of improvement in HbA1c over 3 years.
All patients with T2DM treated within a major academic healthcare system during 2015-2020, who had at least one HbA1c value > 8.5% within 3 years from their last HbA1c were included in analysis. Patients were grouped as improved glycemic control (last HbA1c ≤ 8.5%) or lack of improvement (last HbA1c > 8.5%). Multivariate logistic regression analysis was performed to assess independent predictors of lack of improvement in glycemic control.
Out of 2,232 patients who met the inclusion criteria, 1,383 had an improvement in HbA1c while 849 did not. In the fully adjusted model, independent predictors of lack of improvement included: younger age (odds ratio, 0.89 per 1-SD [12 years]; 95% CI, 0.79-1.00), female gender (1.30, 1.08-1.56), presence of hypertension (1.29, 1.08-1.55), belonging to Black race (1.32, 1.04-1.68, White as reference), living in low income area (1.86,1.28-2.68, high income area as reference), and insurance coverage other than Medicare (1.32, 1.05-1.66). Presence of current smoking was associated with a paradoxical improvement in HbA1c (0.69, 0.47-0.99). In a subgroup analysis, comparing those with all subsequent HbA1c values > 8.5% (N = 444) to those with all subsequent HbA1c values < 8.5% (N = 341), similar factors were associated with lack of improvement, but smoking was no longer significant.
We conclude that socioeconomic factors like race, type of insurance coverage and living in low-income areas are associated with lack of improvement in HbA1c over a period of 3-years in people with T2DM. Intervention strategies focused on low-income neighborhoods need to be designed to improve diabetes management.
专业指南建议大多数糖尿病患者糖化血红蛋白（HbA1c）<7%，血糖控制目标较宽松的患者HbA1c<8.5%。然而，许多2型糖尿病（T2DM）患者无法达到理想的HbA1c目标。本研究评估了3年内HbA1c未改善的相关因素。
纳入2015年至2020年在一个主要学术医疗系统接受治疗的所有T2DM患者，这些患者在末次HbA1c测定后的3年内至少有一次HbA1c值>8.5%。患者分为血糖控制改善组（末次HbA1c≤8.5%）和未改善组（末次HbA1c>8.5%）。进行多因素逻辑回归分析以评估血糖控制未改善的独立预测因素。
在符合纳入标准的2232例患者中，1383例HbA1c有所改善，849例未改善。在完全调整模型中，未改善的独立预测因素包括：年龄较小（每降低1个标准差[12岁]的优势比为0.89；95%置信区间为0.79至1.00）、女性（1.30，1.08至1.56）、存在高血压（1.29，1.08至1.55）、属于黑人种族（1.32，1.04至1.68，以白人为参照）、生活在低收入地区（1.86，1.28至2.68，以高收入地区为参照）以及医疗保险覆盖范围非医疗保险（1.32，1.05至1.66）。当前吸烟与HbA1c出现矛盾性改善相关（0.69，0.47至0.99）。在亚组分析中，将所有后续HbA1c值>8.5%的患者（N = 444）与所有后续HbA1c值<8.5%的患者（N = 341）进行比较，未改善的相关因素相似，但吸烟不再具有统计学意义。
我们得出结论，种族、保险覆盖类型和生活在低收入地区等社会经济因素与T2DM患者3年内HbA1c未改善有关。需要设计针对低收入社区的干预策略以改善糖尿病管理。
