2型糖尿病における心血管予防治療の最適化のための調整されたケア:ランダム化臨床試験

Neha J Pagidipati¹, Adam J Nelson^1,2, Lisa A Kaltenbach¹

¹Duke Clinical Research Institute, Durham, North Carolina.

JAMA

|March 6, 2023

まとめ

2型糖尿病と動脈硬化性心血管疾患の成人のための3つの主要な治療法の使用が著しく増加し,エビデンスに基づくケアが改善されました.

科学分野:

心臓病科
内分泌学
臨床試験

背景:

2型糖尿病における動脈硬化性心血管疾患 (ASCVD) リスク減少のための根拠に基づいた治療法は十分に活用されていない.
このギャップは,ガイドラインに沿ったケアを改善するための介入の必要性を強調しています.

研究の目的:

2型糖尿病とASCVDの患者に対する3つの主要なエビデンスベースの治療法の処方量の増加における多面的な介入の有効性を評価する.
治療には高強度スタチン,ACEI/ARB,SGLT2阻害剤および/またはGLP-1RAが含まれています.

主な方法:

43の米国心臓診療所を対象としたクラスターランダム化臨床試験.
2型糖尿病とASCVDの3つの治療クラスをすべて受けていない被験者 (n=1049) は,介入群または通常の治療群にランダムに分けられた.
介入には障壁の評価,ケアパスの開発,臨床医教育,データフィードバック,患者ツールが含まれていました.

主要な成果:

介入グループでは,すべての3つの治療クラスを処方された参加者の割合が著しく高かった (37. 9% vs 14. 5%,調整されたOR4. 38).
通常の治療と比較して,介入群の個々の治療クラスで処方率が増加した.
ASCVDリスク因子の変化や死亡/入院の複合二次結果と有意な関連性は見つかりませんでした.

結論:

2型糖尿病とASCVDの成人の間で推奨される根拠に基づいた治療法の導入を効果的に増加させました.
構造化された介入は,この集団におけるガイドラインの遵守と潜在的ASCVDリスク管理を改善することを示唆しています.

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