Nathan D M, McKitrick C, Larkin M, Schaffran R, Singer D E
Department of Medicine, Massachusetts General Hospital, Boston 02114, USA.
Am J Med. 1996 Feb;100(2):157-63. doi: 10.1016/s0002-9343(97)89453-3.
New methods of measuring and controlling glycemia in diabetes mellitus have been developed and implemented in the past 10 years. We examined whether glycemia, as measured by glycosylated hemoglobin, changed in outpatient insulin-dependent diabetes mellitus (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM) populations between 1985 and 1993 and whether contemporaneous changes in therapy could account for observed changes in glycemia.
Outpatients were selected based on having glycated hemoglobin (HbA1c) measured in the Massachusetts General Hospital laboratory during March 1985 (IDDM n = 94 and NIDDM n = 137) or during March 1993 (IDDM n = 89 and NIDDM n = 118). Chart reviews established demographic and clinical characteristics, including frequency of blood glucose self-monitoring, insulin injections, office visits, and HbA1c measurements during the year prior to the HbA1c result.
Mean HbA1c level was significantly lower in the 1993 IDDM cohort compared with the 1985 cohort (8.77% +/- 1.7% versus 9.47% +/- 2.1%, P = 0.014). In the NIDDM cohorts, the difference in mean HbA1c did not achieve statistical significance (8.35% +/- 1.6% in 1993 versus 8.75% +/- 2.1% in 1985, P = 0.09); however, when adjusted for differences in NIDDM duration, HbA1c in the 1993 cohort was significantly lower than that in the 1985 cohort. The largest decrease in HbA1c in NIDDM was in patients treated with insulin (9.53% +/- 2.0% versus 8.54% +/- 1.5% in 1985 and 1993, respectively, P = 0.004). Multiple linear regression analyses demonstrated that increased frequency of self-monitoring and of insulin injections were associated with lower HbA1c in IDDM.
The level of average glycemia has decreased in IDDM patients over the past 8 years, attributable, at least in part, to an increased frequency of monitoring and of insulin injections. Glycemia decreased in NIDDM, especially in the subset of patients treated with insulin. This temporal shift in glycemic control should have a salutary effect on the development of long-term microvascular and neurologic complications.
在过去10年中已开发并实施了测量和控制糖尿病患者血糖的新方法。我们研究了在1985年至1993年间，门诊胰岛素依赖型糖尿病（IDDM）和非胰岛素依赖型糖尿病（NIDDM）人群中糖化血红蛋白所测得的血糖水平是否发生了变化，以及同期治疗的改变是否可以解释所观察到的血糖变化。
根据1985年3月（IDDM患者94例，NIDDM患者137例）或1993年3月（IDDM患者89例，NIDDM患者118例）在马萨诸塞州总医院实验室测量的糖化血红蛋白（HbA1c）来选择门诊患者。病历回顾确定了人口统计学和临床特征，包括糖化血红蛋白结果前一年的血糖自我监测频率、胰岛素注射次数、门诊就诊次数以及糖化血红蛋白测量情况。
与1985年队列相比，1993年IDDM队列的平均HbA1c水平显著降低（8.77%±1.7%对9.47%±2.1%，P = 0.014）。在NIDDM队列中，平均HbA1c的差异未达到统计学显著性（1993年为8.35%±1.6%，1985年为8.75%±2.1%，P = 0.09）；然而，在对NIDDM病程差异进行校正后，1993年队列的HbA1c显著低于1985年队列。NIDDM中HbA1c下降最大的是接受胰岛素治疗的患者（1985年和1993年分别为9.53%±2.0%和8.54%±1.5%，P = 0.004）。多元线性回归分析表明，自我监测频率和胰岛素注射次数增加与IDDM患者较低的HbA1c相关。
在过去8年中，IDDM患者的平均血糖水平有所下降，至少部分归因于监测频率和胰岛素注射次数的增加。NIDDM患者的血糖水平下降，尤其是在接受胰岛素治疗的患者亚组中。血糖控制的这种时间变化应该对长期微血管和神经并发症的发生产生有益影响。
