秘鲁2型糖尿病患者与非2型糖尿病患者心血管危险因素相关性的医生认知

Jesús Rocca
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摘要

背景:由于心血管(CV)疾病是秘鲁人口死亡的主要原因之一,特别是2型糖尿病(T2D)患者,患者的CV危险因素评估应尽可能均匀地进行。本研究的目的是确定秘鲁不同专家对t2dm患者和非t2dm患者心血管危险因素的看法。方法:采用在线问卷调查的方式,方便地抽取来自不同医学专业的医生进行问卷调查。问卷评估了医生对有或无T2D患者的14个CV危险因素的感知,根据三个等级:非常重要、中等重要和轻微重要。我们通过图表和卡方检验评估了医学专业之间的差异,并确定了每个专业之间一致性最高(≥90%)的“非常重要”的危险因素。结果:共有156名医生参与问卷调查,包括内分泌科(30%)、心脏科(26%)、内科(18%)、肾病科(13%)和全科(13%)。在T2D患者中,BMI≥30、高LDL胆固醇水平、甘油三酯≥150mg /dL和高尿酸血症的重要性在不同医学专业之间存在统计学差异。无T2D患者同样如此;甘油三酯≥150mg /dL,高尿酸血症,糖尿病前期,肝脂肪变性。除全科医生外,所有专科均对至少一个风险因素达成了共识,尽管这些风险因素在他们之间是异质的。在所有专业中达成共识的唯一风险因素是高血压。结论:受访医生认为高血压和吸烟是t2dm患者最重要的心血管危险因素,其次是LDL-c水平和蛋白尿。心脏病学家和内分泌学家对心血管危险因素给出了相同的评估。对于没有T2D的人,吸烟被认为是最重要的心血管危险因素,其次是高血压和蛋白尿。
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Physicians’ Perception of the Relevance of Cardiovascular Risk Factors in Patients with and without Type 2 Diabetes in Peru
Background: Since cardiovascular (CV) disease is one of the principal causes of mortality among Peruvian population, especially in people with type 2 diabetes (T2D), patient´s CV risk factors evaluation should be done as homogenously as possible. The aim of this study was to determinate what was the perception of different specialists in Peru, of CV risk factors in patients with and without T2D. Methods: An on-line questionnaire on a convenient sample of physicians, from different medical specialties, was answered. The questionnaire assessed the physicians’ perception of fourteen CV risk factors in patients with and without T2D, according to three ratings: very important, moderately important, and slightly important. We assessed the differences between medical specialties through graphs and chi-square tests, and also identified the risk factors considered as “very important” with the highest (≥90%) consensus amongst each specialty. Results: A total of 156 physicians responded to the questionnaire, composed by endocrinologists (30%), cardiologists (26%), internists (18%), nephrologists (13%) and general practitioners (13%). In patients with T2D the importance of BMI ≥30, high LDL cholesterol level, triglycerides ≥ 150 mg/dL, and hyperuricemia were statistically different across medical specialties. Likewise In patients without T2D; triglycerides ≥150 mg/dL, hyperuricemia, pre diabetes, and hepatic steatosis. With the exception of general practitioners, consensus on at least one risk factor was attained in all specialties, albeit these risk factors were heterogeneous amongst them. The only risk factor that reached consensus across all specialties was high blood pressure. Conclusion: Hypertension and smoking were the most important CV risk factors in T2D patients valued by the surveyed physicians, followed by levels of LDL-c and albuminuria. Cardiologists as well as endocrinologists, gave the same assessment to CV risk factors. For people without T2D, smoking was recognized as the most important CV risk factor, followed by hypertension and albuminuria.
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