澳大利亚城乡地区原住民和托雷斯海峡岛民在全科医疗就诊时的糖尿病监测与控制趋势：一项利用国家全科医疗数据库（医学洞察）数据的重复横断面研究。

Trends in diabetes monitoring and control among Aboriginal and Torres Strait Islander Peoples attending general practice in urban and rural locations in Australia: a repeated cross-sectional study using data from a national general practice database (MedicineInsight).

作者信息

Liddell Antoinette, Pink Natalie, Baldim Jardim Nobre Fernanda, Bernardo Carla, Williams Susan, Stocks Nigel, Gonzalez-Chica David

机构信息

The University of Adelaide Rural Clinical School, Adelaide, South Australia, Australia

The University of Adelaide Rural Clinical School, Adelaide, South Australia, Australia.

出版信息

BMJ Open. 2025 Aug 6;15(8):e093031. doi: 10.1136/bmjopen-2024-093031.

DOI:10.1136/bmjopen-2024-093031

PMID:40774702

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12336607/

Abstract

OBJECTIVE

To determine the proportion of Aboriginal and/or Torres Strait Islander Peoples with diabetes who were monitored according to recommended national guidelines and had their clinical parameters within recommended targets. We also examined trends over time (2013-2022) and compared urban and rural areas.

DESIGN

A repeated cross-sectional study using data from a national general practice database (MedicineInsight, 2013-2022).

SETTING

De-identified electronic health records (EHR) of people attending 427 mainstream general practices across Australia.

PARTICIPANTS

This study included all Aboriginal and/or Torres Strait Islander adults (18+ years) diagnosed with diabetes mellitus who were regular patients (attended at least once a year in three consecutive years) within the MedicineInsight database.

OUTCOME MEASURES

Outcomes measured were (i) monitoring of blood glucose, lipids, blood pressure (BP), renal function and Body Mass Index (BMI)/waist circumference (WC) and (ii) achieving recommended targets: glycosylated haemoglobin (HbA1c) ≤7.0%, fasting glucose 4-7 mmol/L, random glucose 5-10 mmol/L, total cholesterol ≤4.0 mmol/L, low-density lipoprotein <2.0 mmol/L, BP ≤130/80 mmHg, estimated glomerular filtration rate >60 mL/min/1.73 m, urine albumin-creatinine ratio (uACR) <2.5 mg/mmol (men); <3.5 (women), BMI <25 kg/m, WC <80 cm (men); <94 (women). Adjusted analyses explored trends and differences in outcomes according to practice remoteness using Australian Statistical Geography Standard (ASGS) classifications: major cities (ASGS-1), inner regional (ASGS-2) or rural/remote (ASGS3-5).

RESULTS

Between 70% and 90% of individuals were monitored for the clinical parameters above, except for BMI/WC (55%-75%). Trends in monitoring over time were similar across remoteness areas, increasing slightly in 2013-2014 and declining from 2019. Among those monitored, 53%-86% achieved targets for blood glucose, lipids and renal function; 32%-42% for BP; and <10% had normal BMI/WC. In 2022, the proportion achieving targets was lower in rural than urban areas for blood glucose (68.4%, 95% CI: 60.8 to 75.9 vs 86.3%, 95% CI: 81.8 to 90.7) and lipids (61.3%, 95% CI: 54.1 to 68.5 vs 79.5%, 95% CI: 73.8 to 85.3).

CONCLUSION

The risk of diabetes complications among Aboriginal and/or Torres Strait Islander Peoples could be reduced by improving management of blood pressure and overweight/obesity in all areas, and blood glucose and lipids in rural areas.

摘要

目的

确定按照国家推荐指南接受监测且临床参数处于推荐目标范围内的原住民和/或托雷斯海峡岛民糖尿病患者的比例。我们还研究了时间趋势（2013 - 2022年）并比较了城乡地区。

设计

一项重复横断面研究，使用来自全国全科医疗数据库（MedicineInsight，2013 - 2022年）的数据。

背景

澳大利亚427家主流全科医疗机构就诊患者的去识别化电子健康记录（EHR）。

参与者

本研究纳入了MedicineInsight数据库中所有被诊断患有糖尿病的原住民和/或托雷斯海峡岛民成年人（18岁及以上），他们是常规患者（连续三年每年至少就诊一次）。

观察指标

观察指标包括：（i）血糖、血脂、血压（BP）、肾功能以及体重指数（BMI）/腰围（WC）的监测；（ii）达到推荐目标：糖化血红蛋白（HbA1c）≤7.0%，空腹血糖4 - 7 mmol/L，随机血糖5 - 10 mmol/L，总胆固醇≤4.0 mmol/L，低密度脂蛋白<2.0 mmol/L，血压≤130/80 mmHg，估计肾小球滤过率>60 mL/min/1.73 m²，尿白蛋白 - 肌酐比值（uACR）<2.5 mg/mmol（男性）；<3.5（女性），BMI<25 kg/m²，WC<80 cm（男性）；<94（女性）。采用澳大利亚统计地理标准（ASGS）分类进行的调整分析探讨了根据医疗机构偏远程度在观察指标上的趋势和差异：大城市（ASGS - 1）、内城区（ASGS - 2）或农村/偏远地区（ASGS3 - 5）。

结果

70%至90%的个体接受了上述临床参数的监测，但BMI/WC监测比例为55% - 75%。不同偏远地区随时间的监测趋势相似，在2013 - 2014年略有上升，自2019年起下降。在接受监测的人群中，53% - 86%达到了血糖、血脂和肾功能目标；32% - 42%达到了血压目标；BMI/WC正常的比例<10%。2022年，农村地区血糖（68.4%，95%CI：60.8至75.9 vs 86.3%，95%CI：81.8至90.7）和血脂（61.3%，95%CI：54.1至68.5 vs 79.5%，95%CI：73.8至85.3）达到目标的比例低于城市地区。