Adherence to insulin and its association with glycaemic control in patients with type 2 diabetes
Adherence to insulin and its association with glycaemic control in patients with type 2 diabetes
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DOI：
10.1093/qjmed/hcm031
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发表时间：
2007-06-01
影响因子：
13.3
通讯作者：
Evans, J. M. M.
中科院分区：
文献类型：
--
作者：
Donnelly, L. A.;Morris, A. D.;Evans, J. M. M.
背景资料：良好的血糖控制改善了2型糖尿病患者的预后，但这在多大程度上取决于胰岛素治疗的依从性尚不确定。目的：研究2型糖尿病患者胰岛素治疗依从性和血糖控制之间的关系。设计：基于观察记录的研究。方法：我们研究了1995年1月1日至2001年9月30日居住在苏格兰泰赛德的所有2型糖尿病患者，他们接受了胰岛素治疗。胰岛素治疗的依从性衡量为推荐剂量的胰岛素覆盖年度天数，根据社区药房分发的药物量和每位患者的推荐剂量水平计算。糖尿病控制（HbAlc）和坚持之间的关联被确定，作为协变量的影响，包括年龄，性别，糖尿病的持续时间和注射次数，每天。结果：共1099人进行了研究：574（52%）男性和525（48%）女性，平均SD年龄62 +/- 12岁，糖尿病持续时间10 - 7年。研究中位时间（胰岛素分发时间）为10 +/- 7（范围366-2446）天。处方胰岛素为58.0 +/- 33.3IU/天，从药房采集的胰岛素为53.6 +/- 27.1 IU/天。因此，对胰岛素的平均依从性为70.6% +/-17.7%。胰岛素依从性（p= 0.0021）、BMI（p= 0.0001）和糖尿病病程（p=0.0314）均为HbA（1c）的显著预测因子。讨论：这些2型糖尿病患者胰岛素依从性较差，依从性与长期代谢控制之间存在显著关系。
Background: Good glycaemic control improves outcomes in patients with type 2 diabetes, but the extent to which this depends on adherence to insulin treatment is uncertain.Aim: To investigate the association between adherence to insulin and glycaemic control in insulin-treated patients with type 2 diabetes.Design: Observational records-based study.Methods: We studied all patients with type 2 diabetes who were resident in Tayside, Scotland from 1 January 1995 to 30 September 2001, and who were treated with insulin. Adherence to insulin treatment was measured as the annual number of days of insulin coverage on the recommended dose, calculated from the amount of drug dispensed at community pharmacies and the recommended dose level for each patient. The association between glycaemic control (HbAlc), and adherence was determined, as was the influence of covariates, including age, sex, duration of diabetes and number of injections per day.Results: A total of 1099 people were studied: 574 (52%) males and 525 (48%) females, mean SD age 62 +/- 12 years, diabetes duration 10 7 years. Median time in the study (time for which insulin was dispensed) was 10 +/- 7 (range 366-2446) days. Insulin prescribed was 58.0 +/- 33.3IU/day and insulin collected from pharmacies was 53.6 +/- 27.1 IU/day. Mean adherence to insulin was thus 70.6% +/- 1 7.7%. Adherence to insulin (p= 0.0021), BMI (p= 0.0001) and diabetes duration (p=0.0314) were all significant predictors of HbA(1c).Discussion: Adherence to insulin appears poor in these type 2 diabetes patients, and there was a significant relationship between adherence and long-term metabolic control.