Quality of Life of Patients with Type 1 Diabetes Mellitus Using Insulin Analog Glargine Compared with NPH Insulin: A Systematic Review and Policy Implications.
Quality of Life of Patients with Type 1 Diabetes Mellitus Using Insulin Analog Glargine Compared with NPH Insulin: A Systematic Review and Policy Implications.
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DOI：
10.1007/s40271-017-0291-3
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发表时间：
2018-08
期刊：
影响因子：
--
通讯作者：
Alvares J
中科院分区：
文献类型：
--
作者：
Almeida PHRF;Silva TBC;de Assis Acurcio F;Guerra Júnior AA;Araújo VE;Diniz LM;Godman B;Almeida AM;Alvares J
甘精胰岛素类似物（GLA）已作为1型糖尿病患者的治疗选择之一，以加强血糖控制。研究表明，低血糖发作频率的降低可改善糖尿病患者的生活质量（QoL）。然而，不同胰岛素之间存在明显的获取成本差异。因此，有必要评估其对生活质量的影响，为卫生当局提供未来的指导。对包括Medline、LILACS、科克伦和EMBASE数据库在内的多个数据库进行了系统性综述，其中包括涉及随机对照试验和队列的几种商定术语组合，以及手动检索和灰色文献。主要结局指标是生活质量的变化。研究的质量和偏倚的风险也进行了评估。在634篇出版物中，最终有8项研究被纳入系统综述。使用了八种不同的生活质量工具（两种通用工具，两种混合工具和四种特定工具），其中最常用的是糖尿病治疗满意度问卷（DTSQ）。系统性综述未一致显示使用GLA与中性鱼精蛋白哈格多恩（NPH）胰岛素的QoL评分总体上存在任何显著差异，无论是作为子集的一部分还是合并为单一评分。只有在DTSQ测量的患者满意度方面，GLA胰岛素的结果始终优于NPH胰岛素，但使用糖尿病患者健康调查（WED）量表时则不然。然而，没有一项队列研究在Newcastle-Ottawa质量量表上得分最高，并且它们通常具有中等质量，研究中存在偏倚。当整理8项研究的结果时，生活质量或患者报告的结局没有一致的差异。有鉴于此，我们认为这些发现不能证明巴西GLA和NPH胰岛素之间目前的价格差异是合理的。本文的在线版本（10.1007/s40271-017-0291-3）包含补充材料，可供授权用户使用。
Insulin analog glargine (GLA) has been available as one of the therapeutic options for patients with type 1 diabetes mellitus to enhance glycemic control. Studies have shown that a decrease in the frequency of hypoglycemic episodes improves the quality of life (QoL) of diabetic patients. However, there are appreciable acquisition cost differences between different insulins. Consequently, there is a need to assess their impact on QoL to provide future guidance to health authorities. A systematic review of multiple databases including Medline, LILACS, Cochrane, and EMBASE databases with several combinations of agreed terms involving randomized controlled trials and cohorts, as well as manual searches and gray literature, was undertaken. The primary outcome measure was a change in QoL. The quality of the studies and the risk of bias was also assessed. Eight studies were eventually included in the systematic review out of 634 publications. Eight different QoL instruments were used (two generic, two mixed, and four specific), in which the Diabetes Treatment Satisfaction Questionnaire (DTSQ) was the most used. The systematic review did not consistently show any significant difference overall in QoL scores, whether as part of subsets or combined into a single score, with the use of GLA versus neutral protamine Hagedorn (NPH) insulin. Only in patient satisfaction measured by DTSQ was a better result consistently seen with GLA versus NPH insulin, but not using the Well-being Inquiry for Diabetics (WED) scale. However, none of the cohort studies scored a maximum on the Newcastle–Ottawa scale for quality, and they generally were of moderate quality with bias in the studies. There was no consistent difference in QoL or patient-reported outcomes when the findings from the eight studies were collated. In view of this, we believe the current price differential between GLA and NPH insulin in Brazil cannot be justified by these findings. The online version of this article (10.1007/s40271-017-0291-3) contains supplementary material, which is available to authorized users.
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DOI：
10.1136/bmj.b2535
发表时间：
2009-07-21
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
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