Kaiser Permanente Washington Health Research Institute, USA.
University of Washington, Department of Epidemiology, USA.
Health Place. 2024 Mar;86:103216. doi: 10.1016/j.healthplace.2024.103216. Epub 2024 Feb 23.
To examine whether built environment and food metrics are associated with glycemic control in people with type 2 diabetes.
We included 14,985 patients with type 2 diabetes using electronic health records from Kaiser Permanente Washington. Patient addresses were geocoded with ArcGIS using King County and Esri reference data. Built environment exposures estimated from geocoded locations included residential unit density, transit threshold residential unit density, park access, and having supermarkets and fast food restaurants within 1600-m Euclidean buffers. Linear mixed effects models compared mean changes of HbA1c from baseline at 1, 3 (primary) and 5 years by each built environment variable.
Patients (mean age = 59.4 SD = 13.2, 49.5% female, 16.6% Asian, 9.8% Black, 5.5% Latino/Hispanic, 57.1% White, 20% insulin dependent, mean BMI = 32.7±7.7) had an average of 6 HbA1c measures available. Participants in the 1st tertile of residential density (lowest) had a greater decline in HbA1c (-0.42, -0.43, and -0.44 in years 1, 3, and 5 respectively) than those in the 3rd tertile (HbA1c = -0.37 at 1- and 3-years and -0.36 at 5-years; all p-values <0.05). Having any supermarkets within 1600 m of home was associated with a greater decrease in HbA1c at 1-year and 3-years compared to having none (all p-values <0.05).
Lower residential density and better proximity to supermarkets may benefit HbA1c control in people with people with type 2 diabetes. However, effects were small and indicate limited clinical significance.
研究 2 型糖尿病患者的建筑环境和食物指标与血糖控制的关系。
我们纳入了来自 Kaiser Permanente Washington 的 14985 名 2 型糖尿病患者的电子健康记录。使用 ArcGIS 对患者地址进行地理编码，并使用 King County 和 Esri 参考数据。从地理编码位置估计的建筑环境暴露包括住宅单元密度、过境门槛住宅单元密度、公园可达性，以及在 1600 米欧几里得缓冲区范围内有超市和快餐店。线性混合效应模型比较了每个建筑环境变量从基线到 1、3（主要）和 5 年的 HbA1c 平均变化。
患者（平均年龄 59.4 ± 13.2，49.5%为女性，16.6%为亚洲人，9.8%为黑人，5.5%为拉丁裔/西班牙裔，57.1%为白人，20%依赖胰岛素，平均 BMI 为 32.7±7.7）有 6 次 HbA1c 测量值。住宅密度（最低）第 1 tertile 的参与者的 HbA1c 下降幅度更大（第 1、3 和 5 年分别为-0.42、-0.43 和-0.44），而第 3 tertile 的参与者的 HbA1c 下降幅度则较小（第 1 年和第 3 年为-0.37，第 5 年为-0.36；所有 p 值均<0.05）。与没有超市相比，家中 1600 米范围内有任何超市与 HbA1c 在 1 年和 3 年的降低有关（所有 p 值均<0.05）。
较低的住宅密度和更接近超市可能有益于 2 型糖尿病患者的 HbA1c 控制。然而，效果较小，表明临床意义有限。
