2型糖尿病合并冠状动脉疾病患者HbA1c控制:南非某三级医院回顾性研究

Lona Mhlaba, Dineo Mpanya, Nqoba Tsabedze
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引用次数: 0

摘要

背景2型糖尿病(T2DM)合并冠状动脉疾病(CAD)的患者心血管事件复发的风险增加。这些患者需要最佳的血糖控制,以防止动脉粥样硬化性心血管疾病(ASCVD)的进展。现代指南建议HbA1c≤7%以减轻这种风险。本研究的目的是评估T2DM合并血管造影证实的ASCVD患者的HbA1c控制。方法:我们对在南非一家三级学术医院治疗的连续T2DM急性和慢性冠状动脉综合征患者进行了横断面、回顾性研究。通过评估急性和慢性冠状动脉综合征指数表现时以及最近随访期间测量的糖化血红蛋白(HbA1c)水平来评估血糖控制。结果T2DM患者262例,平均年龄61.3±10.4岁。T2DM患者有110例(42.0%)表现为st段抬高型心梗,69例(26.3%)表现为非st段抬高型心梗,43例(16.4%)表现为不稳定型心绞痛,40例(15.3%)表现为稳定型心绞痛。中位持续时间为16.5个月(IQR: 7-29)后,28.7%的研究参与者HbA1c≤7%。在多变量logistic回归分析中,女性血糖控制不良(HbA1c高于7%)的可能性较小[优势比(OR): 0.42, 95%可信区间(CI): 0.19-0.95, p=0.038]。此外,使用二甲双胍单药治疗的T2DM患者(OR: 0.34, 95% CI: 0.14-0.82, p=0.017)和心电图上st段下降的患者(OR: 0.39, 95% CI: 0.16-0.96, p=0.041)血糖控制不良的可能性较小。结论中位病程16.5个月后,只有28.7%的T2DM合并CAD患者HbA1c≤7%。这一发现强调了在这一高危人群中对最佳糖尿病控制的大量未满足需求。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
HbA1c control in type 2 diabetes mellitus patients with coronary artery disease: a retrospective study in a tertiary hospital in South Africa
Background Type 2 diabetes mellitus (T2DM) patients with coronary artery disease (CAD) have an increased risk of recurrent cardiovascular events. These patients require optimal glucose control to prevent the progression of atherosclerotic cardiovascular disease (ASCVD). Contemporary guidelines recommend an HbA1c ≤7% to mitigate this risk. The aim of this study was to evaluate HbA1c control in T2DM patients with angiographically proven ASCVD. Methods We conducted a cross-sectional, retrospective study on consecutive T2DM patients with acute and chronic coronary syndromes managed in a tertiary academic hospital in South Africa. Glycaemic control was assessed by evaluating the glycated haemoglobin (HbA1c) level measured at index presentation with acute and chronic coronary syndromes and during the most recent follow-up visit. Results The study population comprised 262 T2DM patients with a mean age of 61.3 ± 10.4 years. At index presentation, 110 (42.0%) T2DM patients presented with ST-segment elevation myocardial infarction, 69 (26.3%) had non-ST-segment elevation myocardial infarction, 43 (16.4%) had unstable angina, and 40 (15.3%) had stable angina. After a median duration of 16.5 months (IQR: 7-29), 28.7% of the study participants had an HbA1c ≤7%. On multivariable logistic regression analysis, females were less likely to have poor glycaemic control (HbA1c above 7%) [odds ratio (OR): 0.42, 95% confidence interval (CI): 0.19-0.95, p=0.038]. Also, T2DM patients prescribed metformin monotherapy (OR: 0.34, 95% CI: 0.14-0.82, p=0.017) and patients with ST-segment depression on the electrocardiogram (OR: 0.39, 95% CI: 0.16-0.96, p=0.041) were less likely to have poor glycaemic control. Conclusion After a median duration of 16.5 months, only 28.7% of T2DM patients with CAD had an HbA1c ≤7%. This finding underscores the substantial unmet need for optimal diabetes control in this very high-risk group.
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