How doctors choose medications to treat type 2 diabetes - A national survey of specialists and academic generalists
How doctors choose medications to treat type 2 diabetes - A national survey of specialists and academic generalists
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DOI：
10.2337/dc06-2499
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发表时间：
2007-06-01
期刊：
影响因子：
16.2
通讯作者：
Nathan, David M.
中科院分区：
文献类型：
--
作者：
Grant, Richard W.;Wexler, Deborah J.;Nathan, David M.
目的：尽管可用药物种类繁多，但血糖控制仍不理想。更有效的药物处方可能会导致更好的控制。然而，医生选择降糖药物的过程却鲜为人知。我们试图研究医生为2型糖尿病患者选择药物的方法。研究设计和方法-我们调查了目前管理2型糖尿病患者的886名普通内科协会(学术通才，应答率30%)或美国糖尿病协会(专家，应答率23%)的医生成员。在三个管理阶段(开始、二线口服药物的使用和胰岛素)中的每一个阶段，受访者在决定给2型糖尿病患者开什么药时，权衡了15个患者、医生和非临床因素的重要性。结果：受访者报告在每个阶段使用了五个主要考虑因素的中位数(四分位数范围4-6)。经常被引用的主要考虑因素包括对患者的痊愈情况/合并症、ALC水平和患者的依从性行为的总体评估，但不包括专家指南/医院算法或患者的年龄。对于胰岛素治疗，学术上的通才更重视患者的依从性(76%的专家对60%的专家，P<；0.001)。这些多面手还发现，患者对注射的恐惧(68%)和患者希望延长非胰岛素治疗(68%)是主要的胰岛素障碍。总体而言，定性因素(例如，坚持、动机、整体健康评估)比定量因素(例如，A、IC、年龄、体重)受到更高的考虑，在0-10分的范围内，平均总分为7.3分，P<；0.001。结论：在我们的调查中，医生在选择治疗高血糖的药物时考虑了广泛的定性和定量因素。药物选择过程的明显复杂性与目前的循证治疗指南形成了鲜明对比。
OBJECTIVE- Glycemic control remains suboptimal despite the wide range of available medications. More effective medication prescription might result in better control. However, the process by which physicians choose glucose-lowering medicines is poorly understood. We sought to study the means by which physicians choose medications for type 2 diabetic patients.RESEARCH DESIGN AND METHODS - We surveyed 886 physician members of either the Society of General Internal Medicine (academic generalists, response rate 30%) or the American Diabetes Association (specialists, response rate 23%) currently managing patients with type 2 diabetes. Respondents weighed the importance of 15 patient, physician, and nonclinical factors when deciding which medications to prescribe for type 2 diabetic subjects at each of three management stages (initiation, use of second-line oral agents, and insulin).RESULTS - Respondents reported using a median of five major considerations (interquartile range 4-6) at each stage. Frequently cited major considerations included overall assessment of the patient's heal th/comorbidity, AlC level, and patient's adherence behavior but not expert guidelines/hospital algorithms or patient age. For insulin initiation, academic generalists placed greater emphasis on patient adherence (76 vs. 60% of specialists, P < 0.001). These generalists also identified patient fear of injections (68%) and patient desire to prolong noninsulin therapy (68%) as major insulin barriers. Overall, qualitative factors (e.g., adherence, motivation, overall health assessment) were somewhat more highly considered than quantitative factors (e.g., A I C, age, weight) with mean aggregate scores of 7.3 vs. 6.9 on a scale of 0-10, P < 0.001.CONCLUSIONS - The physicians in our survey considered a wide range of qualitative and quantitative factors when making medication choices for hyperglycemia management. The apparent complexity of the medication choice process contrasts with current evidence-based treatment guidelines.