Verlato G, Muggeo M, Bonora E, Corbellini M, Bressan F, de Marco R
Division of Metabolic Diseases, University of Verona, Italy.
Diabetes Care. 1996 Mar;19(3):211-3. doi: 10.2337/diacare.19.3.211.
The aim of the present study is to compare the survival of patients attending diabetes centers with that of patients exclusively consulting family physicians.
The study was carried out in the frame of the Verona Diabetes Study, a population-based survey of known diabetes prevalence with a subsequent 5-year mortality follow-up. A cohort of 7,488 diabetic patients were identified on 31 December 1986 from three different sources: a drug consumption database, family physicians, and diabetes centers (one for children and one for adults). As of 31 December 1986, 3,288 patients in the entire cohort exclusively consulted their own family physicians, while 4,200 patients also had periodic examinations at the diabetes centers. The life status of the diabetic cohort was ascertained on 31 December 1991.
Compared with the nondiabetic population, diabetic patients seen only by family physicians had a standardized mortality ratio (SMR) of 1.62 (95% CI 1.51-1.74), while patients attending both family physicians and diabetes centers showed an SMR of 1.44 (1.34-1.54), the difference being statistically significant (P = 0.017). The 5-year survival probability, estimated by the Kaplan-Meier method, was 0.76 (0.75-0.78) in patients seen only by family physicians and 0.81 (0.80-0.82) in patients attending the diabetes centers. Multivariate analysis by Cox regression model showed that attending the diabetes centers was an independent predictor of survival even after adjusting for sex, age, and therapy of diabetes. The relative risk of 5-year all-cause mortality amounted to 0.83 (0.75-0.92) in patients also attending the diabetes centers with respect to patients consulting only family physicians (P < 0.001).
These data on patients' survival indicate that diabetes centers play a crucial role in diabetes care. As a corollary, an integration between primary-care physicians and diabetes centers is strongly recommended.
本研究旨在比较就诊于糖尿病中心的患者与仅咨询家庭医生的患者的生存率。
本研究是在维罗纳糖尿病研究的框架内进行的，这是一项基于人群的已知糖尿病患病率调查，并随后进行了5年的死亡率随访。1986年12月31日，从三个不同来源确定了一组7488名糖尿病患者：一个药物消费数据库、家庭医生和糖尿病中心（一个儿童糖尿病中心和一个成人糖尿病中心）。截至1986年12月31日，整个队列中有3288名患者仅咨询自己的家庭医生，而4200名患者还在糖尿病中心进行定期检查。1991年12月31日确定了糖尿病队列的生命状态。
与非糖尿病人群相比，仅由家庭医生诊治的糖尿病患者的标准化死亡率（SMR）为1.62（95%CI 1.51 - 1.74），而同时就诊于家庭医生和糖尿病中心的患者的SMR为1.44（1.34 - 1.54），差异具有统计学意义（P = 0.017）。通过Kaplan-Meier方法估计，仅由家庭医生诊治的患者的5年生存概率为0.76（0.75 - 0.78），而就诊于糖尿病中心的患者为0.81（0.80 - 0.82）。Cox回归模型的多变量分析表明，即使在调整了性别、年龄和糖尿病治疗后，就诊于糖尿病中心仍是生存的独立预测因素。与仅咨询家庭医生的患者相比，同时就诊于糖尿病中心的患者5年全因死亡率的相对风险为0.83（0.75 - 0.92）（P < 0.001）。
这些关于患者生存的数据表明，糖尿病中心在糖尿病护理中起着至关重要的作用。作为必然结果，强烈建议基层医疗医生与糖尿病中心之间进行整合。
