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在2型糖尿病患者中开始胰岛素治疗:有效性,并发症和资源利用率
R A Hayward1, W G Manning, S H Kaplan
1Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Medical Center, 48113-0170, USA. rhayward@umich.edu
JAMA
|December 5, 1997
概括
对2型糖尿病的胰岛素治疗改善了血糖控制,特别是对于那些基线水平较低的人来说. 然而,它增加了资源使用,并且很少在现实世界临床实践中实现严格的控制.
科学领域:
- 内分泌学和新陈代谢学
- 临床实践研究 临床实践研究
- 医疗服务研究 医疗服务研究
背景情况:
- 实验研究表明,在受控条件下,胰岛素治疗对于2型糖尿病是安全有效的.
- 关于胰岛素在临床实践中的实际有效性,并发症率和资源利用情况的数据有限.
研究的目的:
- 在现实临床环境中评估2型糖尿病患者胰岛素治疗的有效性,并发症率和资源利用率.
- 为了比较胰岛素治疗和由全科医生管理的其他药物治疗方案之间的结果.
主要方法:
- 1990年至1993年期间,一个大型卫生维护组织的8668名2型糖尿病患者参与的队列研究.
- 通过使用临床,调查和行政数据评估资源的使用 (住院,访问,实验室测试,家庭血糖监测) 和血糖控制.
- 详细的病例组合数据,包括总疾病负担指数,在1738名患者的子样本中收集.
主要成果:
- 一年后,胰岛素治疗使血红蛋白A1c (HbA1c) 降低了0.9个百分点,但2年后60%的HbA1c仍然≥8%.
- 基线血糖控制较差的患者 (HbA1c 13%) 与基线HbA1c 9%的患者相比,显示出明显更大的HbA1c降低.
- 胰岛素使用者表现出更高的资源使用,包括更多的实验室测试,门诊访问和家庭血糖监测,与硫基尿素使用者相比,无论疾病的严重程度如何. 报告的低血糖症状为15%,低血糖住院率较低.
结论:
- 在一般医生管理的2型糖尿病患者中开始胰岛素治疗是安全的,对于那些最初血糖控制不佳的人来说是适度有效的.
- 胰岛素治疗与资源利用率的增加有关,并且很少有效地实现严格的血糖控制,即使对于中度控制的患者也是如此.
- 现实世界的临床实践表明,胰岛素治疗提供了适度的益处,但需要仔细考虑资源影响和可实现的血糖目标.
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