PDF(Pubmed)
Abstract：
This study aimed at evaluating diabetic control and compliance with testing guidelines, across healthcare facilities of Gauteng Province, South Africa, as well as factors associated with time to achieve control. South Africa\'s estimated total unmet need for care for patients with type 2 diabetes mellitus is 80%.
The data of 511 781 patients were longitudinally evaluated. Results were reported by year, age category, race, sex, facility and test types. HbA1C of ≤7% was reported as normal, >7 - ≤9% as poor control and >9% as very poor control. The chi-squared test was used to assess the association between a first-ever HbA1C status and variables listed above. The Kaplan-Meier analysis was used to assess probability of attaining control among those who started with out-of-control HbA1C. The extended Cox regression model assessed the association between time to attaining HbA1C control from date of treatment initiation and several covariates. We reported hazard ratios, 95% confidence intervals and p-values. Data is reported for 511 781 patients with 705 597 laboratory results. Poorly controlled patients constituted 51.5%, with 29.6% classified as very poor control. Most poorly controlled patients had only one test over the entire study period. Amongst those who started with poor control status and had at least two follow-up measurements, the likelihood of achieving good control was higher in males (adjusted Hazard Ratio (aHR) = 1.16; 95% CI:1.12-1.20; p<0.001) and in those attending care at hospitals (aHR = 1.99; 95% CI:1.92-2.06; p<0.001).
This study highlights poor adherence to guidelines for diabetes monitoring.
The data of 511 781 patients were longitudinally evaluated. Results were reported by year, age category, race, sex, facility and test types. HbA1C of ≤7% was reported as normal, >7 - ≤9% as poor control and >9% as very poor control. The chi-squared test was used to assess the association between a first-ever HbA1C status and variables listed above. The Kaplan-Meier analysis was used to assess probability of attaining control among those who started with out-of-control HbA1C. The extended Cox regression model assessed the association between time to attaining HbA1C control from date of treatment initiation and several covariates. We reported hazard ratios, 95% confidence intervals and p-values. Data is reported for 511 781 patients with 705 597 laboratory results. Poorly controlled patients constituted 51.5%, with 29.6% classified as very poor control. Most poorly controlled patients had only one test over the entire study period. Amongst those who started with poor control status and had at least two follow-up measurements, the likelihood of achieving good control was higher in males (adjusted Hazard Ratio (aHR) = 1.16; 95% CI:1.12-1.20; p<0.001) and in those attending care at hospitals (aHR = 1.99; 95% CI:1.92-2.06; p<0.001).
This study highlights poor adherence to guidelines for diabetes monitoring.
摘要：
目的：本研究旨在评估糖尿病控制和测试指南的依从性，在豪登省的医疗机构，南非,以及与实现控制的时间相关的因素。南非估计2型糖尿病患者的护理总需求为80%。
■对511781例患者的数据进行纵向评估。结果按年份报告，年龄类别,种族,性别,设施和测试类型。HbA1C≤7%报告为正常，>7-≤9%为控制不良，>9%为控制非常差。卡方检验用于评估首次HbA1C状态与上述变量之间的关联。Kaplan-Meier分析用于评估那些开始失控的HbA1C中达到控制的概率。扩展的Cox回归模型评估了从治疗开始之日起达到HbA1C控制的时间与几个协变量之间的关联。我们报告了危险比，95%置信区间和p值。报告了511781名患者的数据，其中705597名实验室结果。控制不佳的患者占51.5%，29.6%被列为非常差的控制。大多数控制不佳的患者在整个研究期间只有一次测试。在那些开始时控制状态不佳并进行了至少两次随访测量的人中，在男性(校正后的危险比(aHR)=1.16;95%CI:1.12-1.20;p<0.001)和在医院就诊的患者(aHR=1.99;95%CI:1.92-2.06;p<0.001)中,患者获得良好控制的可能性较高.
结论：本研究强调糖尿病监测指南的依从性差。
■对511781例患者的数据进行纵向评估。结果按年份报告，年龄类别,种族,性别,设施和测试类型。HbA1C≤7%报告为正常，>7-≤9%为控制不良，>9%为控制非常差。卡方检验用于评估首次HbA1C状态与上述变量之间的关联。Kaplan-Meier分析用于评估那些开始失控的HbA1C中达到控制的概率。扩展的Cox回归模型评估了从治疗开始之日起达到HbA1C控制的时间与几个协变量之间的关联。我们报告了危险比，95%置信区间和p值。报告了511781名患者的数据，其中705597名实验室结果。控制不佳的患者占51.5%，29.6%被列为非常差的控制。大多数控制不佳的患者在整个研究期间只有一次测试。在那些开始时控制状态不佳并进行了至少两次随访测量的人中，在男性(校正后的危险比(aHR)=1.16;95%CI:1.12-1.20;p<0.001)和在医院就诊的患者(aHR=1.99;95%CI:1.92-2.06;p<0.001)中,患者获得良好控制的可能性较高.
结论：本研究强调糖尿病监测指南的依从性差。
