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协调护理以优化2型糖尿病的心血管预防疗法:随机临床试验
Neha J Pagidipati1, Adam J Nelson1,2, Lisa A Kaltenbach1
1Duke Clinical Research Institute, Durham, North Carolina.
JAMA
|March 6, 2023
概括
协调干预显著增加了2型糖尿病和动脉样性心血管疾病的3种关键治疗方法的使用,改善了基于证据的护理.
科学领域:
- 心脏病学
- 内分泌学
- 临床试验
背景情况:
- 对降低2型糖尿病风险的动脉样硬化心血管疾病 (ASCVD) 基于证据的治疗方法未得到充分利用.
- 这种差距凸显了改善指导方针护理的必要性.
研究的目的:
- 评估多方面干预措施在增加对2型糖尿病和ASCVD患者的三个关键基于证据的治疗类别的有效性.
- 这些疗法包括高强度的他类药物,ACEI/ARB以及SGLT2抑制剂和/或GLP-1RA.
主要方法:
- 一个集群随机临床试验,涉及43个美国心脏病诊所.
- 参与者 (n=1049) 患有2型糖尿病和ASCVD并非所有3种治疗类别被随机分配到干预组或常规治疗组.
- 这项干预涉及障碍评估,护理途径开发,临床医生教育,数据反和患者工具.
主要成果:
- 干预组显示,所有3种治疗类别的参与者比例显著高 (37. 9% vs 14. 5%,调整后的OR为4. 38).
- 与通常治疗相比,干预组的每个治疗类别的处方率都增加了.
- 没有发现与ASCVD风险因素的变化或死亡/住院的复合次要结果有显著的关联.
结论:
- 一个协调,多方面的干预有效地增加了推的基于证据的治疗在2型糖尿病和ASCVD的成年人.
- 这些发现表明,结构化的干预措施可以改善该群体的准则遵守和潜在的ASCVD风险管理.
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