Background

Glycemic control has remained an enigma despite a large number of anti-diabetic drugs being available. Clinical practice and guidelines have focussed largely on optimal and rational use of anti-diabetes drugs to achieve care goals. This study aims to delineate factors impacting glycemic control from real-world data.

Methods

Retrospective, cross-sectional data comprising 15,689 prescriptions from 4647 people living with diabetes and attending an endocrine clinic over a 5-year period was extracted from EMR (electronic medical records) of the clinic. Data pertaining to drugs prescribed, glycemic control attained and patient behavioral factors like diet, drug and exercise adherence was analysed to delineate the contribution of patient or care team-dependent factors towards glycemic control.

Results

Factors related to patient behavior affected glycemic control linearly with statistically lower HbA1c in people with better adherence to diet, medications and exercise. People who did any self-monitoring of blood glucose at home had significantly better glycemic control. On the other hand, a number of medications were negatively associated with glycemic control. Hypoglycemia had no impact on glycemic control. A number of visits to treating physician were positively associated with glycemic control but impact plateaued after 6 visits.

Conclusion

Patient behavior and activation-related factors are predominant drivers of glycemic control.

中文翻译：

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是什么推动了糖尿病患者的血糖控制？

背景

尽管有大量抗糖尿病药物可用，但血糖控制仍然是一个谜。临床实践和指南主要关注抗糖尿病药物的最佳和合理使用，以实现护理目标。本研究旨在从现实世界的数据中描述影响血糖控制的因素。

方法

从诊所的 EMR（电子病历）中提取了回顾性横断面数据，其中包括来自 4647 名糖尿病患者并在 5 年内就诊于内分泌诊所的 15689 份处方。分析了与处方药、达到的血糖控制和患者行为因素（如饮食、药物和运动依从性）有关的数据，以描述患者或护理团队依赖因素对血糖控制的贡献。

结果

与患者行为相关的因素线性影响血糖控制，在饮食、药物和运动依从性更好的人群中，HbA1c 在统计学上较低。在家进行任何自我血糖监测的人的血糖控制明显更好。另一方面，许多药物与血糖控制呈负相关。低血糖对血糖控制没有影响。多次就诊与血糖控制呈正相关，但在 6 次就诊后影响趋于平稳。

结论

患者行为和激活相关因素是血糖控制的主要驱动因素。