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基于HbA1c趋势的治疗强化发生率在2型糖尿病患者中
Erika Sugito1, Takehiro Sugiyama2,3,4,5, Ryotaro Bouchi1,2
1Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Japan Institute for Health Security, Tokyo, Japan.
Journal of diabetes investigation
|November 30, 2025
概括
2型糖尿病的临床惯性很常见,尽管HbA1c水平高,但近一半的患者没有加强治疗. 监测HbA1c趋势对于有效的糖尿病管理至关重要.
科学领域:
- 内分泌学 在内分泌学.
- 糖尿病管理 糖尿病管理
- 临床研究 临床研究
背景情况:
- 临床惯性,即尽管血糖控制不理想,但无法升级2型糖尿病治疗的失败,会显著影响患者的治疗结果.
- 现有的临床惯性定义不包括血糖趋势,限制了对治疗强化模式的全面理解.
研究的目的:
- 根据血红蛋白A1c (HbA1c) 趋势,定义和评估2型糖尿病的治疗强化.
- 确定与2型糖尿病患者治疗强化相关的因素.
主要方法:
- 来自2016年至2023年的日本糖尿病综合数据库项目 (J-DREAMS) 数据的分析.
- 纳入标准:2型糖尿病患者90天没有改变处方,90天内两次咨询,在两次访问时HbA1c水平≥7% (或≥7.5%对于≥65岁的患者).
- 治疗强化被定义为在第二次咨询时调整药物 (添加,增加剂量或切换).
主要成果:
- 在5,683名患者中,有19.9%的患者经历了治疗强化.
- 强化在HbA1c趋势较高或恶化时更为常见,但大约50%的HbA1c>8%或恶化趋势的患者没有接受强化治疗.
- 强化预测因素包括HbA1c水平,咨询间的HbA1c变化,口服低血糖剂的数量,以及使用硫尿素或化物.
结论:
- 在2型糖尿病中,当血糖目标未达到时,HbA1c趋势应指导治疗强化决策.
- 临床惯性仍然是管理2型糖尿病的一个重大挑战,强调需要改进治疗策略.
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