目的:比较不同种族的代谢目标成就的变化(欧洲人,毛利人和Pasifika)在奥克兰的2型糖尿病(T2DM)患者中,新西兰(NZ),1994年至2013年。
方法:纳入32,237例患者。收缩压(SBP)的调整边际差异(欧洲参考),体重指数(BMI),HbA1c和总胆固醇,在基线时使用多变量混合效应模型估计达到代谢目标的比例,1-,2-,3-,4-,5年,针对协变量进行调整。
结果:与欧洲人相比,毛利人和帕西菲卡不断,HbA1c(分别为0.3%(3.5mmol/mol)和0.6%(6.8mmol/mol)和BMI(分别为1.5和0.3kg/m2)显着升高,但SBP(分别为-1.8和-3.4mmHg)和TG(分别为-0.03和-0.34mmol/L)降低,和不显著TC(分别为+0.004和+0.01),5年的随访。虽然49%的欧洲人在目标HbA1c之内,只有30%的毛利人和27%的Pasifika实现了这一点。相反,41%的欧洲人,46%的毛利人和59%的Pasifika达到了SBP目标(所有P<0.0001)。
结论:在毛利人和Pasifika中,管理高血糖似乎比治疗高血压和血脂异常更具挑战性。新的抗高血糖治疗,解决健康素养问题,迫切需要社会经济和文化障碍来管理和自我管理,以减少这些差距。
OBJECTIVE: To compare variations in metabolic target achievement by ethnicity (Europeans, Māori and
Pasifika) among patients with type 2 diabetes (T2DM) in Auckland, New Zealand (NZ) between 1994 and 2013.
METHODS: 32,237 patients were enrolled. Adjusted marginal difference (European as reference) of systolic blood pressure (SBP), body mass index (BMI), HbA1c and total cholesterol, alongside the proportion achieving metabolic targets were estimated using multivariable mixed effect models at baseline, 1-, 2-, 3-, 4-, and 5-years, adjusted for covariates.
RESULTS: Compared with Europeans, Māori and
Pasifika had continuously, significantly higher HbA1c (by 0.3% (+3.5 mmol/mol) and 0.6% (+6.8 mmol/mol) respectively and BMI (+1.5 and +0.3 kg/m2 respectively) but lower SBP (-1.8 and -3.4 mmHg respectively) and TG (-0.03 and -0.34 mmol/L respectively), and insignificantly TC (+0.004 and +0.01 respectively), by 5-years of follow-up. While 49% Europeans were within target HbA1c, this was achieved by only 30% Māori and 27%
Pasifika. Conversely, 41% Europeans, 46% Māori and 59%
Pasifika achieved the SBP target (all P < 0.0001).
CONCLUSIONS: Managing hyperglycemia appears to be more challenging than treating hypertension and dyslipidemia among Māori and
Pasifika. New anti-hyperglycemia treatments, addressing health literacy, socioeconomic and any cultural barriers to management and self-management are urgently needed to reduce these disparities.