Adherence to insulin therapeutic regimens in patients with type 1 diabetes. A nationwide survey in Brazil
Adherence to insulin therapeutic regimens in patients with type 1 diabetes. A nationwide survey in Brazil
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DOI：
10.1016/j.diabres.2016.07.011
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发表时间：
2016-10-01
影响因子：
5.1
通讯作者：
Negrato, C. A.
中科院分区：
文献类型：
--
作者：
Gomes, M. B.;Negrato, C. A.
目的：确定巴西 1 型糖尿病患者自我报告的胰岛素治疗方案依从性与人口统计学、临床数据、血糖控制和心血管危险因素之间的关系。方法：这是一项 2011 年 8 月至 2014 年 8 月在巴西 10 个城市进行的横断面、多中心研究。数据来自 1698 名患者，年龄为 30.0 +/- 11.90 岁（55.5% 为女性，53.6% 为白人），糖尿病病程为 15.4 +/- 1.9 年。使用改编的 4 项 Morisky 用药量表 (MMAS) 问卷评估依从性。结果：共有 166 名 (9.8%)、717 名 (42.2%) 和 815 名 (48.0%) 患者分别报告对其胰岛素治疗方案的最大依从性（第 0 组）、中度依从性（第 1 组）和最小依从性（第 2 组）。与第 1 组 8.9 +/- 2.0% (74 +/- 22 mmol/mol) 和第 0 组 8.6 +/- 1.9% (71 +/- 21 mmol/mol) 相比，第 2 组患者的 HbA1c 显着差异为 9.2 +/- 2.2% (77 +/- 25 mmol/mol) (p = 0.003)。多变量逻辑分析显示，与较高的胰岛素治疗方案依从性相关的显着自变量是年龄较大、饮食依从性较高、最近一个月自我报告的低血糖发生率较低、经济状况较低和居住在东南地区。胰岛素治疗方案、每日胰岛素注射次数、血糖自我监测、性别、种族和心血管危险因素与依从性无关。结论：根据 MMAS 4 项量表，大多数巴西 T1D 患者没有遵守规定的胰岛素治疗方案。该工具最初应该用于识别不遵守处方的患者，并帮助他们克服遵守处方的障碍。 (C) 2016 Elsevier Ireland Ltd. 保留所有权利。
Aims: Determine the relationship between self-reported adherence to insulin therapeutic regimens in Brazilian patients with type 1 diabetes and demographic, clinical data, glycemic control and cardiovascular risk factors.Methods: This was a cross-sectional, multicenter study conducted between August 2011 and August 2014 in 10 Brazilian cities. Data were obtained from 1698 patients, aged 30.0 +/- 11.90 years (55.5% females, 53.6% Caucasians) with a diabetes duration of 15.4 +/- 1.9 years. Adherence was evaluated using an adapted 4-item Morisky Medication Scale (MMAS) questionnaire.Results: A total of 166 (9.8%), 717 (42.2%) and 815 (48.0%) of the patients reported maximal (group 0), moderate (group 1) and minimal (group 2) adherence to their insulin therapeutic regimen, respectively. A significant difference in HbA1c was observed in patients from group 2, 9.2 +/- 2.2% (77 +/- 25 mmol/mol) compared to group 1, 8.9 +/- 2.0% (74 +/- 22 mmol/mol) and group 0, 8.6 +/- 1.9% (71 +/- 21 mmol/mol) (p = 0.003). A multivariate logistic analysis revealed that the significant independent variables related to higher insulin therapeutic regimen adherence were older age, higher adherence to diet, lower rate of self-reported hypoglycemia in the last month, low economic status and living in the Southeast region. Insulin therapeutic regimens, number of daily insulin injections, self-monitoring of blood glucose, gender, ethnicity and cardiovascular risk factors were not related to adherence.Conclusions: Most Brazilian T1D patients did not adhere to their prescribed insulin therapeutic regimen, according to the MMAS 4-item scale. This tool should be initially used to identify non-adherent patients and help them overcome the barriers to adherence to their prescriptions. (C) 2016 Elsevier Ireland Ltd. All rights reserved.