Quality of life and patient-perceived difficulties in the treatment of type 2 diabetes.
Quality of life and patient-perceived difficulties in the treatment of type 2 diabetes.
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DOI：
10.1900/rds.2012.9.46
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发表时间：
2012-01-01
期刊：
影响因子：
--
通讯作者：
Heymann, Anthony
中科院分区：
文献类型：
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作者：
Tamir, Orly;Wainstein, Julio;Heymann, Anthony
背景：临床证据表明，患者在实施早期胰岛素治疗时存在困难和依从性问题。因此，个体化治疗目标对于优化糖尿病治疗是必要的，正如目前新的ADA/EASD指南所承认的那样。更好地描述患者在实施早期胰岛素治疗过程中感受到的困难，可能有助于改善患者对治疗方案的依从性，并为个别患者优化治疗方案。目的：评估口服降糖药(OHAs)和胰岛素治疗每增加一次或两次，患者在生活质量(QOL)和患者感受到的医疗保健困难方面的差异。方法：对714名糖尿病患者进行横断面样本分析，这些患者接受OHAs治疗或胰岛素治疗，每天一到两次。通过趋势分析和组间比较，评估糖尿病患者的特定QOL、总体QOL以及对特定糖尿病治疗属性相关困难认知的差异。结果：无论血糖控制程度如何，单独接受OHAs治疗的患者在通过口服药物的数量进行评估时，其QOL测量结果并无显著差异。与接受单一OHA治疗的控制较差的患者相比，接受两个OHA治疗的控制较好的患者对糖尿病治疗属性相关的困难的知觉较低。接受2个OHA治疗的控制较差的患者和接受3个OHA治疗的控制较好的患者具有相似的生活质量和感觉到的护理困难。然而，与口服方案相比，基于胰岛素的替代方案始终与显著更高的疼痛感知和更低的总体生活质量相关。结论：从患者的角度来看，口腔治疗是实现治疗目标的首选策略，因为OHA的加入与较低的生活质量或患者感知的护理困难无关。如果考虑早期胰岛素治疗，医生应该针对具体的糖尿病治疗特点，主要是疼痛问题，以促进改善生活质量和疾病控制。
BACKGROUND: Clinical evidence points to patient-perceived difficulties and compliance problems in implementing early insulin therapy. Therefore, individual treatment aims are necessary to optimize diabetes therapy, as currently acknowledged by the new ADA/EASD guidelines. Better characterization of patient-perceived difficulties in the implementation of early insulin treatment may contribute to improved compliance and optimal tailoring of treatment regimens for the individual patient.OBJECTIVES: To assess differences in quality of life (QoL) and patient-perceived difficulties in health care with every addition of oral hypoglycemic agents (OHAs) and insulin therapy.METHODS: The analysis was conducted on a cross-sectional sample of 714 diabetic patients treated with OHAs or with insulin once or twice daily. Differences in diabetes-specific QoL, overall QoL, and perception of difficulties associated with specific diabetes treatment attributes were evaluated using trend analysis and comparisons between groups. The contribution of each diabetes treatment attribute to QoL measures and glycemic control was also assessed.RESULTS: No significant differences were found in QoL measures among patients treated exclusively with OHAs when these patients were assessed by the number of oral agents, irrespective of the degree of glycemic control. Better controlled patients treated with 2 OHAs, compared with poorly controlled patients treated with a single OHA, had a lower perception of difficulties associated with diabetes treatment attributes. Poorly controlled patients treated with 2 OHAs and better controlled patients treated with 3 OHAs had similar QoL and perceived difficulties with care. However, the insulin-based alternative was consistently associated with a significantly higher perception of pain and lower overall QoL when compared with the oral regimens. Multivariate models accounted for 52% and 32% of the variance in QoL measures.CONCLUSIONS: From the patients' perspective, oral therapy is the preferred strategy for attaining the treatment goals since the addition of OHAs was not associated with lower QoL or patient-perceived difficulties with care. If early insulin treatment is considered, physicians should address specific diabetes treatment characteristics, mainly the issue of pain, to promote improved QoL and disease control.