背景:2型糖尿病(T2DM)是西方世界的主要健康问题。尽管广泛实施综合护理计划,但仍有2型糖尿病患者控制不佳。共享决策(SDM)过程中的共享目标设定可提高患者对治疗方案的依从性和依从性。在我们对集群随机对照辩论试验的二次分析中,我们调查了患者是否患有共享vs.非共享HbA1c治疗目标,实现他们的血糖目标。
方法:在德国初级保健机构中,我们在基线干预前收集数据,6、12和24个月。招募时HbA1c≥8.0%(64mmol/mol)的T2DM患者,基线和24个月后的完整数据符合本分析。使用广义估计方程分析,我们分析了24个月HbA1c目标之间的关系,基于他们的共享与非共享状态,年龄,性别,教育,合作伙伴身份,控制基线HbA1c和胰岛素治疗。
结果:从N=833名基线招募的患者,分析了105名全科医生(GP)的n=547(65.7%)。53.4%的患者为男性,33.1%没有合伙人,64.4%的人文化程度较低,平均年龄为64.6(SD10.6),60.7%的人在基线时服用胰岛素,平均基线HbA1c为9.1(SD1.0).对于287名患者(52.5%),据报道,全科医生使用HbA1c作为共同目标,260名患者(47.5%)作为非共享目标。235名患者(43.0%)在两年后达到HbA1c目标,312例患者(57.0%)漏诊。多变量分析表明,共享与非共享HbA1c目标设定,年龄,性别,教育与HbA1c目标的实现无关。然而,没有伴侣生活的患者显示出更高的达不到目标的风险(p=.003;OR1.89;95%CI1.25-2.86).
结论:针对HbA1c水平的T2DM患者的共同目标设定对目标实现没有显著影响。可以假设,SDM过程中与患者相关的临床结果相关的共同目标设定尚未被完全捕获。
背景:该试验在ISRCTN注册处注册,参考ISRCTN70713571。
Type 2 diabetes mellitus (T2DM) is a major health problem in the western world. Despite a widespread implementation of integrated care programs there are still patients with poorly controlled T2DM. Shared goal setting within the process of Shared Decision Making (SDM) may increase patient\'s compliance and adherence to treatment regimen. In our secondary analysis of the cluster-randomized controlled DEBATE
trial, we investigated if patients with shared vs. non-shared HbA1c treatment goal, achieve their glycemic goals.
In a German primary care setting, we collected data before intervention at baseline, 6, 12 and 24 months. Patients with T2DM with an HbA1c ≥ 8.0% (64 mmol/mol) at the time of recruitment and complete data at baseline and after 24 months were eligible for the presented analyses. Using a generalized estimating equation analysis, we analysed the association between the achievement of HbA1c goals at 24 months based on their shared vs. non-shared status, age, sex, education, partner status, controlled for baseline HbA1c and insulin therapy.
From N = 833 recruited patients at baseline, n = 547 (65.7%) from 105 General Practitioners (GPs) were analysed. 53.4% patients were male, 33.1% without a partner, 64.4% had a low educational level, mean age was 64.6 (SD 10.6), 60.7% took insulin at baseline, mean baseline HbA1c was 9.1 (SD 1.0). For 287 patients (52.5%), the GPs reported to use HbA1c as a shared goal, for 260 patients (47.5%) as a non-shared goal. 235 patients (43.0%) reached the HbA1c goal after two years, 312 patients (57.0%) missed it. Multivariable analysis shows that shared vs. non-shared HbA1c goal setting, age, sex, and education are not associated with the achievement of the HbA1c goal. However, patients living without a partner show a higher risk of missing the goal (p = .003; OR 1.89; 95% CI 1.25-2.86).
Shared goal setting with T2DM patients targeting on HbA1c-levels had no significant impact on goal achievement. It may be assumed, that shared goal setting on patient-related clinical outcomes within the process of SDM has not been fully captured yet.
The
trial was registered at ISRCTN registry under the reference ISRCTN70713571.