Optimization of insulin therapy in patients with Type 2 diabetes mellitus: beyond basal insulin
Optimization of insulin therapy in patients with Type 2 diabetes mellitus: beyond basal insulin
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DOI：
10.1111/j.1464-5491.2012.03586.x
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发表时间：
2012-07-01
影响因子：
3.5
通讯作者：
Ivanyi, T.
中科院分区：
文献类型：
--
作者：
Blak, B. T.;Smith, H. T.;Ivanyi, T.
迪亚贝特。地中海医院。29，e13e20(2012)摘要旨在描述在英国初级保健中使用基础胰岛素治疗的2型糖尿病患者，以及是否使用口服抗糖尿病药物，并评估胰岛素治疗模式和解释治疗变化的因素。方法对英国健康改善网络初级保健数据库中的2型糖尿病患者进行回顾性分析。2006年1月至6月期间接受基础胰岛素治疗的患者被跟踪调查至2009年7月。结果3185例患者，平均年龄65.6岁[标准差(SD)12.4]，男性占50.9%，糖尿病病程中位数9.6年，基础胰岛素使用量中位数1.3年，86.5%的患者在过去12个月内接受过口服抗糖尿病药物治疗。平均随访2.9年(SD 1.0)，59.8%的患者在整个随访期间维持基础胰岛素，基线时平均HbA1C为69 mm o l/m ol(SD 19；8.4%，SD 1.7)，随访期间平均65 mm o l/m ol(SD 17；8.1%，SD 1.6)。在随访期间，6.9%的患者停止使用胰岛素，19.3%的患者病情加重，14.1%的患者转为进食或预混胰岛素。强化餐前HbA1c平均值为77 mmol/mol(SD18；9.2%，SD1.6)，研究结束时HbA1c平均值为71 mmol/mol(SD21；8.6%，SD2.0)。改用预混胰岛素的患者在改变前糖化血红蛋白平均值为80 mmol/mol(SD18；9.5%，SD1.7)，研究结束时HbA1c平均值为69 mmol/mol(SD17；8.5%，SD1.5)。糖化血红蛋白升高和较长的糖尿病病程解释了强化和转换。结论大多数患者的糖化血红蛋白水平在基线和强化/转流后均高于53 mm ol/m ol(<；7%)。HbA1c水平通过强化/切换而降低，这表明胰岛素的变化确实有一些影响。尽管糖化血红蛋白水平高于推荐水平，但大多数患者并未改变胰岛素治疗。面对不令人满意的临床结果，不改变治疗的原因尚不清楚。有必要进行进一步的研究，以探索改变治疗的障碍。
Diabet. Med. 29, e13e20 (2012) Abstract Aims To describe patients with Type 2 diabetes mellitus treated with basal insulin, with or without oral antidiabetics in UK primary care, and evaluate insulin treatment patterns and factors explaining changes in therapy. Methods Retrospective analysis of patients with Type 2 diabetes within The Health Improvement Network UK primary care database. Patients receiving basal insulin between January and June 2006 were followed until July 2009. Results Analysis included 3185 patients, mean age 65.6 years [standard deviation (SD) 12.4], 50.9% men, median diabetes duration 9.6 years, median basal insulin use 1.3 years, 86.5% had received oral antidiabetics in the previous 12 months. Mean follow-up was 2.9 years (SD 1.0), 59.8% patients maintained basal insulin throughout follow-up with a mean HbA1C of 69 mmol/mol (SD 19; 8.4%, SD 1.7) at baseline and 65 mmol/mol (SD 17; 8.1%, SD 1.6) during follow-up. During follow-up, 6.9% of patients discontinued, 19.3% intensified with and 14.1% switched to prandial or premixed insulin. Patients who intensified (prandial) had a mean HbA1c of 77 mmol/mol (SD 18; 9.2%, SD 1.6) before change and a mean HbA1c of 71 mmol/mol (SD 21; 8.6%, SD 2.0) at the end of the study. Those switching to premixed insulin had a mean HbA1c of 80 mmol/mol (SD 18; 9.5%, SD 1.7) before change and a mean HbA1c of 69 mmol/mol (SD 17; 8.5%, SD 1.5) at the end of the study. Increasing HbA1c and longer diabetes duration explained intensification and switch. Conclusions The majority of patients had HbA1c above the 53 mmol/mol (< 7%) target at baseline and post-intensification/switch. The HbA1c levels were reduced by intensification/switch suggesting that insulin changes did have some impact. Most patients did not change insulin treatment despite having higher than recommended HbA1c levels. Reasons for not changing treatment in face of unsatisfactory clinical outcomes are unclear. Further research is warranted to explore barriers towards therapy change.