Diabetes Care：美国糖尿病患者“三达标率”较高

　　美国学者Sarah Stark Casagrande等报告，2007-2010年间有18.8%的美国糖尿病患者糖化血红蛋白（HbA1c）、血压和低密度脂蛋白胆固醇（LDL-C）水平同时达标，达标率是我国糖尿病患者（5.6%）的3倍以上。研究于2013年2月15日在线发表于《糖尿病护理》（Diabetes Care）杂志。

　　研究者利用1988-2010年美国国立卫生和营养调查（NHANES）数据，对4926例成年糖尿病患者数据进行了分析。结果显示，2007-2010年美国糖尿病患者HbA1c水平（<7.0%）、血压（<130/80 mm Hg）和LDL-C（<100 mg/dl）达标率依次为52.5%、51.1%和56.2%，3项达标率为18.8%。研究者表示，从1988年到1994年，上述指标的控制情况得到了明显的改善；糖尿病患者中他汀的应用率也从4.2%（1988-1994年）大幅上升至51.4%（2007-2010年）。与非西班牙裔白人相比，墨西哥裔患者HbA1c和LDL-C达标率明显降低，血压和LDL-C达标的非西班牙裔黑人患者较少。与非西班牙裔黑人相比，墨西哥裔患者中HbA1c达标者比例较低。此外，年轻患者中HbA1c和LDL-C达标者的比例较低。

与糖尿病相关的拓展阅读：

• Diabetes Care：食用红肉使妊娠期糖尿病风险大增
• PLOS ONE：强化降糖或使肥胖糖尿病患者获益
• Diabetes Care：经皮氧分压可预测糖尿病患者心血管风险
• JGIM：血糖达标非糖尿病患者心血管获益关键
• Pediatrics：首部儿童2型糖尿病防治指南
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The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010

OBJECTIVE To determine the prevalence of people with diabetes who meet hemoglobin A1c (A1C), blood pressure (BP), and LDL cholesterol (ABC) recommendations, and their current statin use, factors associated with goal achievement, and changes in the proportion achieving goals between 1988 and 2010.

RESEARCH AND DESIGN METHODS Data were cross-sectional from the National Health and Nutrition Examination Surveys (NHANES) from 1988–1994, 1999–2002, 2003–2006, and 2007–2010. Participants were 4,926 adults aged ≥20 years who self-reported a previous diagnosis of diabetes and completed the household interview and physical examination (n = 1,558 for valid LDL levels). Main outcome measures were A1C, BP, and LDL cholesterol, in accordance with the American Diabetes Association recommendations, and current use of statins.

RESULTS In 2007–2010, 52.5% of people with diabetes achieved A1C <7.0% (<53 mmol/mol), 51.1% achieved BP <130/80 mmHg, 56.2% achieved LDL <100 mg/dL, and 18.8% achieved all three ABCs. These levels of control were significant improvements from 1988 to 1994 (all P < 0.05). Statin use significantly increased between 1988–1994 (4.2%) and 2007–2010 (51.4%, P < 0.01). Compared with non-Hispanic whites, Mexican Americans were less likely to meet A1C and LDL goals (P < 0.03), and non-Hispanic blacks were less likely to meet BP and LDL goals (P < 0.02). Compared with non-Hispanic blacks, Mexican Americans were less likely to meet A1C goals (P < 0.01). Younger individuals were less likely to meet A1C and LDL goals.

CONCLUSIONS Despite significant improvement during the past decade, achieving the ABC goals remains suboptimal among adults with diabetes, particularly in some minority groups. Substantial opportunity exists to further improve diabetes control and, thus, to reduce diabetes-related morbidity and mortality.