NEJM：美国糖尿病防治十年进展回顾

　　近日发表在《新英格兰医学杂志》（NEJM）上的一项研究表明，1999年-2010年美国糖尿病患者降糖达标率提高了8%，将近12%的患者降压达标，21%的患者LDL胆固醇水平降低。然而33%-49%的患者未能降糖达标，每5例糖尿病患者中就有1例未能戒烟。

　　研究主要负责人Mohammed Ali医生表示，全美患者对糖尿病的阻击取得了缓慢而有成效的进展。

与糖尿病相关的拓展阅读：

• Diabetes Care：良好的血糖和血压控制有益于延长糖尿病患者生存期
• 第一时相胰岛素分泌减少是我国2型糖尿病关键诱因
• Diabetic Med：高血压患者治疗时HDL低预示新发糖尿病风险更高
• AACE2013：糖尿病治疗方案
• NEJM：糖尿病治疗有进展但仍存不足 更多信息请点击：有关糖尿病更多资讯

Achievement of Goals in U.S. Diabetes Care, 1999–2010
Background
Tracking national progress in diabetes care may aid in the evaluation of past efforts and identify residual gaps in care.
Methods
We analyzed data for adults with self-reported diabetes from the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System to examine risk-factor control, preventive practices, and risk scores for coronary heart disease over the 1999–2010 period.
Results
From 1999 through 2010, the weighted proportion of survey participants who met recommended goals for diabetes care increased, by 7.9 percentage points (95% confidence interval [CI], 0.8 to 15.0) for glycemic control (glycated hemoglobin level <7.0%), 9.4 percentage points (95% CI, 3.0 to 15.8) for individualized glycemic targets, 11.7 percentage points (95% CI, 5.7 to 17.7) for blood pressure (target, <130/80 mm Hg), and 20.8 percentage points (95% CI, 11.6 to 30.0) for lipid levels (target level of low-density lipoprotein [LDL] cholesterol, <100 mg per deciliter [2.6 mmol per liter]). Tobacco use did not change significantly, but the 10-year probability of coronary heart disease decreased by 2.8 to 3.7 percentage points. However, 33.4 to 48.7% of persons with diabetes still did not meet the targets for glycemic control, blood pressure, or LDL cholesterol level. Only 14.3% met the targets for all three of these measures and for tobacco use. Adherence to the recommendations for annual eye and dental examinations was unchanged, but annual lipid-level measurement and foot examination increased by 5.5 percentage points (95% CI, 1.6 to 9.4) and 6.8 percentage points (95% CI, 4.8 to 8.8), respectively. Annual vaccination for influenza and receipt of pneumococcal vaccination for participants 65 years of age or older rose by 4.5 percentage points (95% CI, 0.8 to 8.2) and 6.9 percentage points (95% CI, 3.4 to 10.4), respectively, and daily glucose monitoring increased by 12.7 percentage points (95% CI, 10.3 to 15.1).
Conclusions
Although there were improvements in risk-factor control and adherence to preventive practices from 1999 to 2010, tobacco use remained high, and almost half of U.S. adults with diabetes did not meet the recommended goals for diabetes care.