Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus
Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus
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DOI：
10.1016/s0140-6736(97)06234-x
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发表时间：
1997-11-22
期刊：
影响因子：
168.9
通讯作者：
Newton, RW
中科院分区：
文献类型：
--
作者：
Morris, AD;Boyle, DIR;Newton, RW
背景胰岛素强化治疗可有效延缓胰岛素依赖型糖尿病（IDDM）微血管并发症的发生和进展。胰岛素治疗依从性不一被认为是导致胰岛素依赖性糖尿病青少年和年轻人血糖控制不佳、糖尿病酮症酸中毒和脆性糖尿病的原因。我们评估了处方胰岛素剂量与所有社区药房的糖尿病审计和研究数据库（DARTS）之间的关联，我们研究了89例患者，平均年龄16（SD 7）岁，糖尿病病程8（4）年，糖化血红蛋白（HbA（1c））8.4（1.9）%，在1993年和1994年到教学医院儿科或成人-成人糖尿病门诊就诊。使用医学推荐的胰岛素剂量和提供的胰岛素处方累积量来计算每年最大可能胰岛素覆盖的天数，表示为依从性指数。血糖控制（HbA（1c）），糖尿病酮症酸中毒发作，所有住院的急性并发症和adherence index.Findings胰岛素之间的关联是modeled.Findings规定在48（19）IU/天，平均胰岛素从药房收集58（25）IU/天。89例患者中有25例（28%）获得的胰岛素低于其处方剂量（平均不足115 [68;范围9-246]胰岛素日/年）。HbA（1c）与依从性指数呈显著负相关（R-2=0.39; p10%），14例（64%）个体的依从性指数提示胰岛素漏服（平均胰岛素不足55天/年）。有36人因糖尿病相关并发症入院。依从性指数与糖尿病酮症酸中毒的住院率呈负相关（p
Background Intensive insulin treatment effectively delays the onset and slows the progression of microvascular complications in insulin-dependent diabetes mellitus (IDDM). Variable adherence to insulin treatment is thought to contribute to poor glycaemic control, diabetic ketoacidosis, and brittle diabetes in adolescents and young adults with IDDM. We assessed the association between the prescribed insulin dose and the amount dispensed from all community pharmacies with the Diabetes Audit and Research in Tayside Scotland (DARTS) database.Methods We studied 89 patients, mean age 16 (SD 7) years, diabetes duration 8 (4) years, and glycosylated haemoglobin (HbA(1c)) 8.4 (1.9)%, who attended a teaching hospital paediatric or young-adult diabetes clinic in 1993 and 1994. The medically recommended insulin dose and cumulative volume of insulin prescriptions supplied were used to calculate the days of maximum possible insulin coverage per annum, expressed as the adherence index. Associations between glycaemic control (HbA(1c)), episodes of diabetic ketoacidosis, and all hospital admissions for acute complications and the adherence index were modelled.Findings Insulin was prescribed at 48 (19) IU/day and mean insulin collected from pharmacies was 58 (25) IU/day. 25 (28%) of the 89 patients obtained less insulin than their prescribed dose (mean deficit 115 [68; range 9-246] insulin days/annum). There was a significant inverse association between HbA(1c) and the adherence index (R-2=0.39; p10%), 14 (64%) of individuals had an adherence index suggestive of a missed dose of insulin (mean deficit 55 insulin days/annum). There were 36 admissions for complications related to diabetes. The adherence index was inversely related to hospital admissions for diabetic ketoacidosis (p