Clinical inertia in patients with T2DM requiring insulin in family practice.
Clinical inertia in patients with T2DM requiring insulin in family practice.
复制标题
在家庭实践中需要胰岛素的 T2DM 患者的临床惯性。
DOI：
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复制
发表时间：
2010
期刊：
影响因子：
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通讯作者：
T. Houston
中科院分区：
文献类型：
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作者：
S. Harris;J. Kapor;C. Lank;A. Willan;T. Houston
目标
描述初级保健机构中 2 型糖尿病 (T2DM) 患者在开始使用胰岛素和随访期间的临床状态，并评估开始使用胰岛素和强化胰岛素的疗效。
设计
IMS Health 数据库中的安大略省 FP 被随机选出，他们在 2006 年 11 月之前的 12 个月内至少开过一次胰岛素，接受参与邀请。符合资格并同意的 FP 为最多 10 名连续符合资格的患者中的每一位完成了一份调查问卷。从 3 个时间点记录患者数据。
设置
加拿大安大略省的家庭诊所。
参加者
109 名 FP 和 379 名 T2DM 患者服用胰岛素（使用或不使用口服药物）。
主要成果指标
糖化血红蛋白 (HbA₁(c)) 水平、每日胰岛素剂量以及开始使用胰岛素时和随后 2 次就诊时伴随口服药物的使用情况。
结果
获得每位患者的胰岛素起始和强化、血糖控制、进一步药物治疗以及相关并发症的数据。从诊断 T2DM 到开始使用胰岛素的平均时间为 9.2 年。开始使用胰岛素前，平均 HbA₁(c) 值为 9.5%；第 2 次就诊时为 8.1%（中位 1.2 年后）；第 3 次就诊时为 7.9%（中位为开始后 3.9 年）。开始时的平均胰岛素剂量为 24 单位，第 2 次访视时为 48 单位，第 3 次访视时为 65 单位。在第 3 次访视时，20% 的患者血糖控制仍然非常差（HbA₁(c) > 9.0%）。除了磺酰脲类药物使用量减少外，口服降糖药的合用情况随时间推移保持不变。
结论
即使对于被确定为需要胰岛素治疗的高风险患者，医生在达到和维持推荐的 HbA₁(c) 目标水平方面也存在临床护理差距。家庭医生需要制定策略来促进胰岛素治疗的早期开始和持续强化。
OBJECTIVE
To describe the clinical status of patients with type 2 diabetes mellitus (T2DM) in the primary care setting at insulin initiation and during follow-up, and to assess the efficacy of insulin initiation and intensification.
DESIGN
Ontario FPs from the IMS Health database who had prescribed insulin at least once in the 12 months before November 2006 were randomly selected to receive an invitation to participate. Eligible and consenting FPs completed a questionnaire for each of up to 10 consecutive eligible patients. Patient data were recorded from 3 time points.
SETTING
Family practices in Ontario, Canada.
PARTICIPANTS
One hundred and nine FPs and 379 of their T2DM patients taking insulin (with or without oral agents).
MAIN OUTCOME MEASURES
Glycated hemoglobin (HbA₁(c)) levels, daily insulin dose, and use of concomitant oral agents at insulin initiation and 2 subsequent visits.
RESULTS
Data from each patient were obtained on insulin initiation and intensification, glycemic control, further pharmacologic therapy, and related complications. Mean time from diagnosis of T2DM to insulin initiation was 9.2 years. Mean HbA₁(c) values were 9.5% before insulin initiation, 8.1% at visit 2 (median 1.2 years later), and 7.9% at visit 3 (median 3.9 years after initiation). Mean insulin dose was 24 units at initiation, 48 units at visit 2, and 65 units at visit 3. At visit 3, 20% of patients continued to have very poor glycemic control (HbA₁(c) > 9.0%). With the exception of a decrease in sulfonylurea use, concomitant use of oral antihyperglycemic agents remained static over time.
CONCLUSION
Even in patients identified as being sufficiently high risk to warrant insulin therapy, a clinical care gap exists in physician efforts to achieve and sustain recommended HbA₁(c) target levels. Family physicians need strategies to facilitate earlier initiation and ongoing intensification of insulin therapy.
胰岛素和糖尿病。
DOI：
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发表时间：
1986
期刊：
Transactions of the Association of American Physicians
影响因子：
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作者：
Mako,ME;Rubenstein,AH
通讯作者：
Rubenstein,AH