The influence of insulin use on glycemic control - How well do adults follow prescriptions for insulin?
The influence of insulin use on glycemic control - How well do adults follow prescriptions for insulin?
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DOI：
10.2337/diacare.28.1.78
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发表时间：
2005-01-01
期刊：
影响因子：
16.2
通讯作者：
Pugh, MJ
中科院分区：
文献类型：
--
作者：
Cramer, JA;Pugh, MJ
目的-本研究的目的是确定胰岛素自我管理和血糖控制之间的关系，并确定与更好的control.Research设计和方法相关的患者特征-一个退伍军人事务部区域数据库被用来确定糖尿病患者的慢性胰岛素治疗（n = 6,222）与剂量定义为单位和剂量的数量。使用药房数据计算2年期间的胰岛素使用率。采用回归分析1）使用人口统计学变量、HbA（lc）水平和糖尿病管理强度的测量来预测处方胰岛素方案的依从性，2）使用人口统计学变量和胰岛素使用率来预测HbA（lc）水平。HbA（Ic）水平为7.98 ± 1.66%。同时口服降糖药（84.89 +/- 16%）高于胰岛素使用（P < 0.0001），但与胰岛素使用相关（r = 0.189，P < 0.0001）。普通最小二乘回归分析显示，种族、HbA（lc）水平和糖尿病管理强度是胰岛素使用的重要预测因素。年龄，种族和胰岛素的使用是显着的预测HbA（LC）levels.CONCLUSIONS -成人规定了一个特定的胰岛素治疗方案平均使用77%的处方剂量，表现出良好的意愿，按照处方。然而，高于推荐水平的HbA（Ic）表明胰岛素使用率、处方方案或两者都不足以在长期使用胰岛素的患者中实现良好的血糖控制（Diabetes Care 28：78-83，2005）。
OBJECTIVE - The purposes of this study were to determine the relationship between insulin self-management and glycemic control and to identify patient characteristics associated with better control.RESEARCH DESIGN AND METHODS - A Department of Veterans Affairs regional database was used to identify patients with diabetes on chronic insulin therapy (n = 6,222) with dose defined as number of units and doses. The rate of insulin use during a 2-year period was calculated using pharmacy data. Regression analyses were used 1) to predict compliance with prescribed insulin regimens using demographic variables, HbA(lc) levels, and a measure of diabetes management intensity and 2) to predict HbA(lc) levels using demographic variables and rates of insulin use.RESULTS - Insulin use was 77.44 +/- 17% of prescribed amounts, including wastage; HbA(lc) levels were 7.98 +/- 1.66%. Concomitant oral hypoglycemic agent use (84.89 +/- 16%) was higher than insulin use (P < 0.0001) but correlated with insulin use (r = 0.189, P < 0.0001). Ordinary least-squares regression showed that race, HbA(lc) levels, and intensity of diabetes management were significant predictors of insulin use. Age, race, and insulin use were significant predictors of HbA(lc) levels.CONCLUSIONS - Adults prescribed a specific insulin regimen averaged using 77% of prescribed doses, demonstrating good intention to follow the prescription. However, HbA(lc) higher than the recommended level suggested that the rate of insulin use, the prescribed regimen, or both were inadequate to achieve good glycemic control in patients with long-term insulin use.Diabetes Care 28:78-83, 2005.