在夸祖鲁-纳塔尔省的公共卫生保健部门,试点研究涉及使用即时糖化血红蛋白(HbA1c)检测筛查和监测糖尿病

IF 0.6 Q4 ENDOCRINOLOGY & METABOLISM
S. Pillay
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引用次数: 2

摘要

背景:糖尿病大流行继续造成患者和经济负担。在全球范围内,改善糖尿病患者血糖控制的策略受到高度追捧。其中一个策略包括使用即时糖化血红蛋白(POCT HbA1c)检测,它为临床医生提供了关于血糖控制的快速信息,也可能有助于其他人的糖尿病诊断。方法:本试点研究在夸祖鲁-纳塔尔省(KZN)的21家公共医疗机构进行了为期三个月的研究(2019年12月- 2020年2月)。所有到这些设施的分诊单位就诊的患者均由护理人员采集其糖尿病病史、POCT HbA1c以及随机血糖进行检测和记录。这些数据已转交给卫生部。结果:共纳入3 541例患者,其中糖尿病患者1 306例,无糖尿病病史患者2 235例。糖尿病队列中实现的中位(+IQR) HbA1c%为6.0(5.2-8.1),其中32.39%的患者未达到目标血糖控制(HbA1c < 7%)。本研究发现,在无糖尿病史的患者中,有相当比例的患者存在糖尿病(HbA1c为6.5%)和糖尿病前期(HbA1c为5.7-6.4%)(分别为45.59%和19.5%)。无DM病史的无症状患者中随机血糖水平≥11.1 mmol/l的361例(16.51%)。在达到目标血糖控制的糖尿病患者数量方面,各医院间存在显著差异。结论:本研究发现,至少有三分之一的糖尿病患者在KZN医疗机构就诊时控制不佳。在没有糖尿病病史的患者中,有相当比例的人血糖水平显示血糖异常(糖尿病前期和显性糖尿病)。政府需要注意这些研究的结果,以制定针对这群以前未确诊的糖尿病患者的策略。HbA1c即时检测为两组患者提供了一种干预途径。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pilot study involving the use of point-of-care glycated haemoglobin (HbA1c) testing for screening and monitoring of diabetes mellitus in the public healthcare sector in KwaZulu-Natal
Background: The diabetes pandemic continues to cause both patient and economic burden. Globally, strategies to improve glycaemic control in patients with diabetes are highly sought after. One such strategy involves the use of point-of-care glycated haemoglobin (POCT HbA1c) testing, which provides clinicians with rapid information on glycaemic control and also may assist with a diagnosis of diabetes in others. Methods: This pilot study was conducted over three months (December 2019–February 2020) at 21 KwaZulu-Natal (KZN) public healthcare facilities. All patients presenting to the triage units of these facilities had their diabetic history taken and POCT HbA1c, together with their random blood glucose, tested and recorded by nursing staff. These data were forwarded to the Department of Health. Results: A total of 3 541 patients were included in study, 1 306 with diabetes and 2 235 with no prior diabetes history. The median (+IQR) HbA1c% achieved in the diabetes cohort was 6.0 (5.2–8.1) with 32.39% of these patients not achieving target glycaemic control (HbA1c < 7%). This study revealed that a significant proportion of the patients with no history of diabetes mellitus (DM) had evidence of diabetes (HbA1c > 6.5%) and pre-diabetes (HbA1c 5.7–6.4%) (45.59% vs. 19.5%, respectively). A total of 361 (16.51%) of these asymptomatic patients with no history of DM had random blood glucose levels of ≥ 11.1 mmol/l. There were significant inter-facility differences noted with regard to the number of patients with diabetes achieving target glycaemic control. Conclusion: This study found that at least one-third of diabetes patients attending these KZN healthcare facilities had sub-optimal control. There was a significant percentage of patients without prior history of DM who had glycaemic levels suggesting dysglycaemia (pre-diabetes and overt diabetes). The Government needs to heed the results of such studies to develop strategies targeting this group of previously undiagnosed diabetes patients. HbA1c point-of-care testing provides one avenue of intervention for both groups of patients.
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