Abstract：
OBJECTIVE: In the management of diabetic patients on insulin therapy, adherence to medication is a key element for avoiding chronic complications. The purpose of this study was to evaluate diabetic patients\' ability to translate glycemic results into an appropriate insulin dose and thus, adherence to insulins.
METHODS: This was an observational, retrospective, monocentric pilot study. Diabetic patients on insulin therapy being followed at the metabolic and endocrine diseases department were divided into two groups depending on their mode of glycemic control at home: capillary glycemia (Notebook group) or interstitial glycemia using the FreeStyle Libre® flash system (FSL group). Adherence was assessed based on the rate of compliance in adapting insulin doses to the prescribed protocols (depending on type of insulin, glycemic targets, and patients\' characteristics) by a pharmacy resident and a senior diabetologist. Good adherence was defined as a minimum rate of 80% of conforming insulin injections for each patient.
RESULTS: A total of 50 patients were included, 35 in the Notebook group and 15 in the FSL group. Two-thirds of patients were non-adherent to insulin. Dose adjustment errors mainly concerned rapid-acting insulin with 51.1% of non- conformities, 10.0% of which were due to underdosing in the Notebook group and 21.7% to overdosing in the FSL group. Hyperglycemia was predominant in both populations with a median time in range of 19.0% in the FSL group and well below recommendations (>70%).
CONCLUSIONS: Despite the use of increasingly efficient, easy-to-use devices in diabetes monitoring, insulin non-adherence and glycemic imbalance are unresolved major issues. Diabetic patients require reinforced medical follow-up for optimal insulin management.
METHODS: This was an observational, retrospective, monocentric pilot study. Diabetic patients on insulin therapy being followed at the metabolic and endocrine diseases department were divided into two groups depending on their mode of glycemic control at home: capillary glycemia (Notebook group) or interstitial glycemia using the FreeStyle Libre® flash system (FSL group). Adherence was assessed based on the rate of compliance in adapting insulin doses to the prescribed protocols (depending on type of insulin, glycemic targets, and patients\' characteristics) by a pharmacy resident and a senior diabetologist. Good adherence was defined as a minimum rate of 80% of conforming insulin injections for each patient.
RESULTS: A total of 50 patients were included, 35 in the Notebook group and 15 in the FSL group. Two-thirds of patients were non-adherent to insulin. Dose adjustment errors mainly concerned rapid-acting insulin with 51.1% of non- conformities, 10.0% of which were due to underdosing in the Notebook group and 21.7% to overdosing in the FSL group. Hyperglycemia was predominant in both populations with a median time in range of 19.0% in the FSL group and well below recommendations (>70%).
CONCLUSIONS: Despite the use of increasingly efficient, easy-to-use devices in diabetes monitoring, insulin non-adherence and glycemic imbalance are unresolved major issues. Diabetic patients require reinforced medical follow-up for optimal insulin management.
摘要：
目的：在糖尿病患者胰岛素治疗的管理中，坚持用药是避免慢性并发症的关键因素。这项研究的目的是评估糖尿病患者将血糖结果转化为适当胰岛素剂量的能力，坚持胰岛素。
方法：这是一个观察性的，回顾性,单中心试点研究。在代谢和内分泌疾病部门接受胰岛素治疗的糖尿病患者根据其在家中的血糖控制方式分为两组：毛细血管血糖（笔记本组）或使用FreeStyleLibre®flash系统的间质性血糖（FSL组）。根据使胰岛素剂量适应规定方案的依从率评估依从性（取决于胰岛素的类型，血糖目标，和患者的特征)由药房住院医师和高级糖尿病学家提供。良好的依从性被定义为每位患者的至少80%的合格胰岛素注射率。
结果：共纳入50例患者，35在Notebook组中，15在FSL组中。三分之二的患者不粘附胰岛素。剂量调整误差主要涉及速效胰岛素，51.1%的不符合性，其中10.0%是由于Notebook组用药不足，21.7%是由于FSL组用药过量。高血糖在两个人群中占主导地位，FSL组的中位时间为19.0％，远低于建议（>70％）。
结论：尽管使用越来越有效，易于使用的设备在糖尿病监测，胰岛素不依从性和血糖失衡是尚未解决的主要问题.糖尿病患者需要加强医学随访以实现最佳胰岛素管理。
方法：这是一个观察性的，回顾性,单中心试点研究。在代谢和内分泌疾病部门接受胰岛素治疗的糖尿病患者根据其在家中的血糖控制方式分为两组：毛细血管血糖（笔记本组）或使用FreeStyleLibre®flash系统的间质性血糖（FSL组）。根据使胰岛素剂量适应规定方案的依从率评估依从性（取决于胰岛素的类型，血糖目标，和患者的特征)由药房住院医师和高级糖尿病学家提供。良好的依从性被定义为每位患者的至少80%的合格胰岛素注射率。
结果：共纳入50例患者，35在Notebook组中，15在FSL组中。三分之二的患者不粘附胰岛素。剂量调整误差主要涉及速效胰岛素，51.1%的不符合性，其中10.0%是由于Notebook组用药不足，21.7%是由于FSL组用药过量。高血糖在两个人群中占主导地位，FSL组的中位时间为19.0％，远低于建议（>70％）。
结论：尽管使用越来越有效，易于使用的设备在糖尿病监测，胰岛素不依从性和血糖失衡是尚未解决的主要问题.糖尿病患者需要加强医学随访以实现最佳胰岛素管理。
