马来西亚 2 型糖尿病护理的真实世界评估：2 型糖尿病治疗依从性指南评估（TARGET-T2D）研究的横断面分析。
Real-world evaluation of care for type 2 diabetes in Malaysia: A cross-sectional analysis of the treatment adherence to guideline evaluation in type 2 diabetes (TARGET-T2D) study.
机构信息
Faculty of Medicine, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR.
出版信息
PLoS One. 2024 Jan 2;19(1):e0296298. doi: 10.1371/journal.pone.0296298. eCollection 2024.
AIM
Given a lack of data on diabetes care performance in Malaysia, we conducted a cross-sectional study to understand the clinical characteristics, control of cardiometabolic risk factors, and patterns of use of guideline-directed medical therapy (GDMT) among patients with type 2 diabetes (T2D), who were managed at publicly-funded hospitals between December 2021 and June 2022.
METHODS
Patients aged ≥18 years with T2D from eight publicly-funded hospitals in the Greater Kuala Lumpur region, who had ≥2 outpatient visits within the preceding year and irrespective of treatment regimen, were eligible. The primary outcome was ≥2 treatment target attainment (defined as either HbA1c <7.0%, blood pressure [BP] <130/80 mmHg, or low-density lipoprotein cholesterol [LDL-C] <1.8 mmol/L). The secondary outcomes were the individual treatment target, a combination of all three treatment targets, and patterns of GDMT use. To assess for potential heterogeneity of study findings, all outcomes were stratified according to prespecified baseline characteristics namely 1) history of atherosclerotic cardiovascular disease (ASCVD; yes/no) and 2) clinic type (Diabetes specialist versus General medicine).
RESULTS
Among 5094 patients (mean±SD age 59.0±13.2 years; T2D duration 14.8±9.2 years; HbA1c 8.2±1.9% (66±21 mmol/mol); BMI 29.6±6.2 kg/m2; 45.6% men), 99% were at high/very high cardiorenal risk. Attainment of ≥2 treatment targets was at 18%, being higher in General medicine than in Diabetes specialist clinics (20.8% versus 17.5%; p = 0.039). The overall statin coverage was 90%. More patients with prior ASCVD attained LDL-C <1.4 mmol/L than those without (13.5% versus 8.4%; p<0.001). Use of sodium-glucose cotransporter-2 (SGLT2) inhibitors (13.2% versus 43.2%), glucagon-like peptide-1 receptor agonists (GLP1-RAs) (1.0% versus 6.2%), and insulin (27.7% versus 58.1%) were lower in General medicine than in Diabetes specialist clinics.
CONCLUSIONS
Among high-risk patients with T2D, treatment target attainment and use of GDMT were suboptimal.
目的
鉴于马来西亚在糖尿病护理绩效方面的数据匮乏，我们开展了一项横断面研究，以了解 2021 年 12 月至 2022 年 6 月期间在吉隆坡大都市区 8 家政府资助医院接受治疗的 2 型糖尿病（T2D）患者的临床特征、心血管代谢风险因素控制情况以及指南指导的医学治疗（GDMT）的使用模式。
方法
年龄≥18 岁、在过去一年中有≥2 次门诊就诊且不论治疗方案如何的 T2D 患者有资格参加研究。主要结局是≥2 项治疗目标达标（定义为糖化血红蛋白（HbA1c）＜7.0%、血压（BP）＜130/80mmHg 或低密度脂蛋白胆固醇（LDL-C）＜1.8mmol/L）。次要结局是各个治疗目标、所有三个治疗目标的组合以及 GDMT 使用模式。为了评估研究结果是否存在潜在的异质性，所有结局均根据预先指定的基线特征进行分层，即 1）是否有动脉粥样硬化性心血管疾病（ASCVD）病史（是/否）和 2）临床科室类型（糖尿病专科与普通内科）。
结果
在 5094 名患者中（平均年龄 59.0±13.2 岁；T2D 病程 14.8±9.2 年；HbA1c 8.2±1.9%（66±21mmol/mol）；BMI 29.6±6.2kg/m2；45.6%为男性），99%的患者存在高/极高心血管肾脏风险。≥2 项治疗目标达标率为 18%，普通内科科室的达标率高于糖尿病专科科室（20.8%比 17.5%；p=0.039）。他汀类药物的总体覆盖率为 90%。有 ASCVD 病史的患者 LDL-C＜1.4mmol/L 的达标率高于无 ASCVD 病史的患者（13.5%比 8.4%；p＜0.001）。与糖尿病专科科室相比，普通内科科室 SGLT2 抑制剂（13.2%比 43.2%）、GLP1-RA（1.0%比 6.2%）和胰岛素（27.7%比 58.1%）的使用率较低。
结论
在高危 T2D 患者中，治疗目标达标和 GDMT 的使用并不理想。
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