影响泰国2型糖尿病患者最佳糖尿病护理及临床结局的因素：一项多层次建模分析

Factors influencing optimal diabetes care and clinical outcomes in Thai patients with type 2 diabetes mellitus: a multilevel modelling analysis.

作者信息

Surawit Apinya, Pongkunakorn Tanyaporn, Manosan Thamonwan, Mongkolsucharitkul Pichanun, Chamnan Parinya, Suvarnabhumi Krishna, Puangpet Thanapat, Suta Sophida, Pumeiam Sureeporn, Pinsawas Bonggochpass, Ophakas Suphawan, Pisitpornsuk Sananon, Utchin Chalita, Mayurasakorn Korapat

机构信息

Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Department of Social Medicine, Sunpasithiprasong Hospital, Ubon Ratchathani, Thailand.

出版信息

BMJ Open. 2024 May 3;14(5):e079415. doi: 10.1136/bmjopen-2023-079415.

DOI:10.1136/bmjopen-2023-079415

PMID:38702083

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11086275/

Abstract

BACKGROUND

Increasing levels of poor glycaemic control among Thai patients with type 2 diabetes mellitus (T2DM) motivated us to compare T2DM care between urban and suburban primary care units (PCUs), to identify gaps in care, and to identify significant factors that may influence strategies to enhance the quality of care and clinical outcomes in this population.

METHODS

We conducted a cross-sectional study involving 2160 patients with T2DM treated at four Thai PCUs from 2019 to 2021, comprising one urban and three suburban facilities. Using mixed effects logistic regression, we compared care factors between urban and suburban PCUs.

RESULTS

Patients attending suburban PCUs were significantly more likely to undergo eye (adjusted OR (AOR): 1.83, 95% CI 1.35 to 1.72), foot (AOR: 1.61, 95% CI 0.65 to 4.59) and HbA (AOR: 1.66, 95% CI 1.09 to 2.30) exams and achieved all ABC (HbA, blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C)) goals (AOR: 2.23, 95% CI 1.30 to 3.83). Conversely, those at an urban PCU were more likely to undergo albuminuria exams. Variables significantly associated with good glycaemic control included age (AOR: 1.51, 95% CI 1.31 to 1.79), T2DM duration (AOR: 0.59, 95% CI 0.41 to 0.88), FAACE (foot, HbA, albuminuria, LDL-C and eye) goals (AOR: 1.23, 95% CI 1.12 to 1.36) and All8Q (AOR: 1.20, 95% CI 1.05 to 1.41). Chronic kidney disease (CKD) was significantly linked with high triglyceride and HbA levels (AOR: 5.23, 95% CI 1.21 to 7.61). Elevated HbA levels, longer T2DM duration, insulin use, high systolic BP and high lipid profile levels correlated strongly with diabetic retinopathy (DR) and CKD progression.

CONCLUSION

This highlights the necessity for targeted interventions to bridge urban-suburban care gaps, optimise drug prescriptions and implement comprehensive care strategies for improved glycaemic control, DR prevention and CKD progression mitigation among in Thai patients with T2DM. The value of the clinical target aggregate (ABC) and the process of care aggregate (FAACE) was also conclusively demonstrated.

摘要

背景

泰国2型糖尿病（T2DM）患者血糖控制不佳的情况日益严重，这促使我们比较城市和郊区基层医疗单位（PCU）的T2DM护理情况，以找出护理差距，并确定可能影响提高该人群护理质量和临床结局策略的重要因素。

方法

我们进行了一项横断面研究，纳入了2019年至2021年在泰国四个PCU接受治疗的2160例T2DM患者，其中包括一个城市医疗设施和三个郊区医疗设施。我们使用混合效应逻辑回归比较了城市和郊区PCU之间的护理因素。

结果

在郊区PCU就诊的患者接受眼部检查（调整后的比值比（AOR）：1.83，95%置信区间1.35至1.72）、足部检查（AOR：1.61，95%置信区间0.65至4.59）和糖化血红蛋白（HbA）检查（AOR：1.66，95%置信区间1.09至2.30）以及实现所有ABC（HbA、血压（BP）和低密度脂蛋白胆固醇（LDL-C））目标（AOR：2.23，95%置信区间1.30至3.83）的可能性显著更高。相反，城市PCU的患者更有可能接受蛋白尿检查。与良好血糖控制显著相关的变量包括年龄（AOR：1.51，95%置信区间1.31至1.79）、T2DM病程（AOR：0.59，95%置信区间0.41至0.88）、FAACE（足部、HbA、蛋白尿、LDL-C和眼部）目标（AOR：1.23，95%置信区间1.12至1.36）和All8Q（AOR：1.20，95%置信区间1.05至1.41）。慢性肾脏病（CKD）与高甘油三酯和HbA水平显著相关（AOR：5.23，95%置信区间1.21至7.61）。HbA水平升高、T2DM病程延长、使用胰岛素、收缩压升高和血脂水平升高与糖尿病视网膜病变（DR）和CKD进展密切相关。