South African Medical Research Council, Cape Town, South Africa.
S Afr Med J. 2024 Mar 18;114(3):e1315. doi: 10.7196/SAMJ.2024.v114i3.1315.
Dyslipidaemia and hypertension care have not been reported in large samples of community-based participants with known diabetes (KD) nor compared with individuals at high risk for diabetes.
To describe the management and associations of dyslipidaemia and hypertension in adults with KD, newly diagnosed diabetes (NDD) and normoglycaemia.
This urban population-based cross-sectional study comprised participants with KD, NDD and normoglycaemia. Participants at high risk for diabetes but without KD underwent oral glucose tolerance tests; those who were subsequently classified as NDD or normoglycaemic were included in this study. Data collection comprised administered questionnaires, clinical measurements and biochemical analyses. Multivariable logistic regressions determined the associations with hypertension and dyslipidaemia management in separate models.
Among 618 participants (82% women), aged median 58 years, there were 339 participants with KD, 70 with NDD and 209 with normoglycaemia. Prevalence of hypertension (BP ≥140/90 mmHg or on treatment) and dyslipidaemia (raised low-density lipoprotein cholesterol >3 mmol/L or on treatment) was highest in KD (89% and 83%) compared with NDD (64% and 74%) and normoglycaemia (66% for both) (p<0.001). Detected or known hypertension was highest in KD (97.4%), followed by NDD (88.9%) and normoglycaemia (80.3%). Among participants with known or detected hypertension, those with KD were most likely to be treated (90.2%) compared with NDD (77.5%) and normoglycaemia (74.5.%). Hypertension control among participants on treatment was highest in KD (69.5%) compared with NDD (51.6%) and normoglycaemia (61.0%). Participants with KD had significantly higher rates of previously detected dyslipidaemia (85.1%) compared with NDD (36.5%) and normoglycaemia (35.5%). KD participants were also more likely to be treated for their previously detected dyslipidaemia (85.4%) and to be controlled when on treatment (56.3%) compared with their counterparts (NDD: 63.2% and 33.3%, normoglycaemia: 61.2% and 43.3%, respectively). Diabetes control was poor; only 20% of those with KD had HbA1c <7%. In the regression models, compared with normoglycaemia, KD was associated with hypertension detection (odds ratio (OR) 6.91, 95% confidence interval (CI) 2.25 - 21.22) and control (OR 2.05, 95% CI 1.04 - 4.02). KD compared with normoglycaemia was associated with dyslipidaemia detection (OR 10.29, 95% CI 5.21 - 20.32) and treatment (OR 3.94, 95% CI 1.68 - 9.27). Sociodemographic and cardiovascular disease risk factors were generally not associated with hypertension or dyslipidaemia management.
Albeit that diabetes control was poor and required better management, dyslipidaemia and hypertension prevalence were higher and better managed in KD than NDD and normoglycaemia. Different approaches are required to improve glucose control in KD, better identify NDD and monitor and prevent diabetes in high-risk individuals. Also important would be to improve care of hypertension and dyslipidaemia in those without KD.
在有已知糖尿病（KD）的大型社区参与者样本中，尚未报道血脂异常和高血压的治疗情况，也未与糖尿病高危人群进行比较。
描述新诊断糖尿病（NDD）和血糖正常的 KD 患者的血脂异常和高血压管理情况，并与糖尿病高危人群进行比较。
本研究为基于人群的横断面研究，纳入了 KD、NDD 和血糖正常的参与者。糖尿病高危人群行口服葡萄糖耐量试验；随后被分类为 NDD 或血糖正常的参与者被纳入本研究。数据收集包括问卷调查、临床测量和生化分析。多变量逻辑回归用于分别评估与高血压和血脂异常管理相关的因素。
在 618 名参与者（82%为女性）中，年龄中位数为 58 岁，其中 339 名参与者患有 KD，70 名患有 NDD，209 名血糖正常。KD 患者的高血压（BP≥140/90mmHg 或正在接受治疗）和血脂异常（低密度脂蛋白胆固醇升高>3mmol/L 或正在接受治疗）的患病率最高（分别为 89%和 83%），高于 NDD（分别为 64%和 74%）和血糖正常（均为 66%）（p<0.001）。在已知或检测到高血压的患者中，KD 患者的高血压检出率最高（97.4%），其次是 NDD（88.9%）和血糖正常（80.3%）。在有已知或检测到高血压的患者中，KD 患者接受治疗的可能性最高（90.2%），高于 NDD（77.5%）和血糖正常（74.5%）。在接受治疗的患者中，KD 患者的高血压控制率最高（69.5%），高于 NDD（51.6%）和血糖正常（61.0%）。KD 患者的血脂异常检出率显著高于 NDD（36.5%）和血糖正常（35.5%）（85.1%）。KD 患者也更有可能接受治疗（85.4%），且在治疗时控制血脂异常的比例更高（56.3%），而 NDD 患者和血糖正常患者的相应比例分别为 63.2%和 33.3%（61.2%和 43.3%）。糖尿病控制较差；只有 20%的 KD 患者的 HbA1c<7%。在回归模型中，与血糖正常相比，KD 与高血压的检出（比值比（OR）6.91，95%置信区间（CI）2.25-21.22）和控制（OR 2.05，95% CI 1.04-4.02）相关。与血糖正常相比，KD 与血脂异常的检出（OR 10.29，95% CI 5.21-20.32）和治疗（OR 3.94，95% CI 1.68-9.27）相关。社会人口统计学和心血管疾病风险因素与高血压或血脂异常管理通常无关。
尽管糖尿病控制较差且需要更好的管理，但 KD 患者的血脂异常和高血压患病率更高，且管理效果优于 NDD 和血糖正常。需要采取不同的方法来改善 KD 患者的血糖控制，更好地识别 NDD，并监测和预防高危人群的糖尿病。改善无 KD 患者的高血压和血脂异常的护理也很重要。
