Abstract：
OBJECTIVE: Our aim in this study was to identify the association between place of residence (metropolitan, urban, rural) and guideline-concordant processes of care in the first year of type 2 diabetes management.
METHODS: We conducted a retrospective cohort study of new metformin users between April 2015 and March 2020 in Alberta, Canada. Outcomes were identified as guideline-concordant processes of care through the review of clinical practice guidelines and published literature. Using multivariable logistic regression, the following outcomes were examined by place of residence: dispensation of a statin, angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB), eye examination, glycated hemoglobin (A1C), cholesterol, and kidney function testing.
RESULTS: Of 60,222 new metformin users, 67% resided in a metropolitan area, 10% in an urban area, and 23% in a rural area. After confounder adjustment, rural residents were less likely to have a statin dispensed (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.79 to 0.87) or undergo cholesterol testing (aOR 0.86, 95% CI 0.83 to 0.90) when compared with metropolitan residents. In contrast, rural residents were more likely to receive A1C and kidney function testing (aOR 1.14, 95% CI 1.08 to 1.21 and aOR 1.17, 95% CI 1.11 to 1.24, respectively). ACEi/ARB use and eye examinations were similar across place of residence.
CONCLUSIONS: Processes of care varied by place of residence. Limited cholesterol management in rural areas is concerning because this may lead to increased cardiovascular outcomes.
METHODS: We conducted a retrospective cohort study of new metformin users between April 2015 and March 2020 in Alberta, Canada. Outcomes were identified as guideline-concordant processes of care through the review of clinical practice guidelines and published literature. Using multivariable logistic regression, the following outcomes were examined by place of residence: dispensation of a statin, angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB), eye examination, glycated hemoglobin (A1C), cholesterol, and kidney function testing.
RESULTS: Of 60,222 new metformin users, 67% resided in a metropolitan area, 10% in an urban area, and 23% in a rural area. After confounder adjustment, rural residents were less likely to have a statin dispensed (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.79 to 0.87) or undergo cholesterol testing (aOR 0.86, 95% CI 0.83 to 0.90) when compared with metropolitan residents. In contrast, rural residents were more likely to receive A1C and kidney function testing (aOR 1.14, 95% CI 1.08 to 1.21 and aOR 1.17, 95% CI 1.11 to 1.24, respectively). ACEi/ARB use and eye examinations were similar across place of residence.
CONCLUSIONS: Processes of care varied by place of residence. Limited cholesterol management in rural areas is concerning because this may lead to increased cardiovascular outcomes.
摘要：
目的：探索居住地(大都市，城市,农村)和2型糖尿病管理第一年的指南一致护理过程。
方法：我们于2015年4月至2020年3月在艾伯塔省对新的二甲双胍使用者进行了一项回顾性队列研究。通过对临床实践指南和已发表的文献的回顾，将结果确定为指南一致的护理过程。使用多变量逻辑回归，按居住地检查以下结果：他汀类药物的分配，血管紧张素转换酶抑制剂（ACEi）或血管紧张素II受体阻滞剂（ARB），眼睛检查,糖化血红蛋白A1C，胆固醇,和肾功能测试.
结果：在60,222名新的二甲双胍用户中，67%居住在大都市地区，10%的城市,23%在农村。混淆调整后，农村居民不太可能使用他汀类药物（aOR0.83;95CI：0.79-0.87）或接受胆固醇测试（aOR0.86;95CI：0.83-0.90），与大都市居民相比。相比之下,农村居民更有可能接受A1C和肾功能检测(分别为aOR1.14;95CI:1.08-1.21和aOR1.17;95CI:1.11-1.24).不同居住地的ACEi/ARB使用和眼部检查相似。
结论：护理过程因居住地而异。农村地区有限的胆固醇管理令人担忧，因为这可能导致心血管结局增加。
方法：我们于2015年4月至2020年3月在艾伯塔省对新的二甲双胍使用者进行了一项回顾性队列研究。通过对临床实践指南和已发表的文献的回顾，将结果确定为指南一致的护理过程。使用多变量逻辑回归，按居住地检查以下结果：他汀类药物的分配，血管紧张素转换酶抑制剂（ACEi）或血管紧张素II受体阻滞剂（ARB），眼睛检查,糖化血红蛋白A1C，胆固醇,和肾功能测试.
结果：在60,222名新的二甲双胍用户中，67%居住在大都市地区，10%的城市,23%在农村。混淆调整后，农村居民不太可能使用他汀类药物（aOR0.83;95CI：0.79-0.87）或接受胆固醇测试（aOR0.86;95CI：0.83-0.90），与大都市居民相比。相比之下,农村居民更有可能接受A1C和肾功能检测(分别为aOR1.14;95CI:1.08-1.21和aOR1.17;95CI:1.11-1.24).不同居住地的ACEi/ARB使用和眼部检查相似。
结论：护理过程因居住地而异。农村地区有限的胆固醇管理令人担忧，因为这可能导致心血管结局增加。
