Abstract：
OBJECTIVE: To assess how medication adherence and home healthcare support influence the role of polypharmacy in induced hypoglycemia events among elderly diabetic patients.
METHODS: This case-crossover study retrieved records on diabetic patients >=65 years with severe hypoglycemia from 2002 to 2012 in Taiwan. Case period defined as 1-3 days before severe hypoglycemia was compared with a preceding control period of the same length, with an all-washout period of 30 days. Moreover, the modifiable effects of medication adherence and home healthcare service use were evaluated by stratified analysis.
RESULTS: Totally 2,237 patients were identified. Polypharmacy use was associated with the risk of severe hypoglycemia. Patients receiving polypharmacy without home healthcare services (aOR: 1.34; 95 % CI: 1.16-1.54) and those with poor adherence to anti-diabetic medications (aOR: 1.48; 95 % CI: 1.24-1.77) were significantly associated with an elevated risk of severe hypoglycemia. In patients with good adherence, non-home healthcare users being prescribed with polypharmacy had a higher risk of severe hypoglycemia. In the group that received home healthcare services, patients with poor adherence using polypharmacy had a higher risk of severe hypoglycemia.
CONCLUSIONS: Good adherence and receiving home healthcare services were associated with a decreased odds of severe hypoglycemic events in elderly diabetic patients, regardless of the fact whether they were prescribed with polypharmacy.
METHODS: This case-crossover study retrieved records on diabetic patients >=65 years with severe hypoglycemia from 2002 to 2012 in Taiwan. Case period defined as 1-3 days before severe hypoglycemia was compared with a preceding control period of the same length, with an all-washout period of 30 days. Moreover, the modifiable effects of medication adherence and home healthcare service use were evaluated by stratified analysis.
RESULTS: Totally 2,237 patients were identified. Polypharmacy use was associated with the risk of severe hypoglycemia. Patients receiving polypharmacy without home healthcare services (aOR: 1.34; 95 % CI: 1.16-1.54) and those with poor adherence to anti-diabetic medications (aOR: 1.48; 95 % CI: 1.24-1.77) were significantly associated with an elevated risk of severe hypoglycemia. In patients with good adherence, non-home healthcare users being prescribed with polypharmacy had a higher risk of severe hypoglycemia. In the group that received home healthcare services, patients with poor adherence using polypharmacy had a higher risk of severe hypoglycemia.
CONCLUSIONS: Good adherence and receiving home healthcare services were associated with a decreased odds of severe hypoglycemic events in elderly diabetic patients, regardless of the fact whether they were prescribed with polypharmacy.
摘要：
目的：评估用药依从性和家庭医疗支持如何影响多重用药在老年糖尿病患者低血糖事件中的作用。
方法：本病例交叉研究检索了台湾2002年至2012年发生严重低血糖的65岁糖尿病患者的记录。将定义为严重低血糖前1-3天的病例期与相同长度的先前对照期进行比较，全冲洗期为30天.此外，我们通过分层分析评估了用药依从性和家庭保健服务使用的可改变效应.
结果：共确认2,237例患者。多重用药与严重低血糖风险相关。没有家庭保健服务（aOR：1.34;95％CI：1.16-1.54）的患者和对抗糖尿病药物依从性差的患者（aOR：1.48;95％CI：1.24-1.77）与严重低血糖风险升高显著相关。在依从性良好的患者中，接受多重用药的非家庭保健患者发生严重低血糖的风险较高.在接受家庭保健服务的群体中，多用药依从性差的患者发生严重低血糖的风险较高.
结论：良好的依从性和接受家庭保健服务与老年糖尿病患者发生严重低血糖事件的几率降低有关。不管他们是否开了复方药。
方法：本病例交叉研究检索了台湾2002年至2012年发生严重低血糖的65岁糖尿病患者的记录。将定义为严重低血糖前1-3天的病例期与相同长度的先前对照期进行比较，全冲洗期为30天.此外，我们通过分层分析评估了用药依从性和家庭保健服务使用的可改变效应.
结果：共确认2,237例患者。多重用药与严重低血糖风险相关。没有家庭保健服务（aOR：1.34;95％CI：1.16-1.54）的患者和对抗糖尿病药物依从性差的患者（aOR：1.48;95％CI：1.24-1.77）与严重低血糖风险升高显著相关。在依从性良好的患者中，接受多重用药的非家庭保健患者发生严重低血糖的风险较高.在接受家庭保健服务的群体中，多用药依从性差的患者发生严重低血糖的风险较高.
结论：良好的依从性和接受家庭保健服务与老年糖尿病患者发生严重低血糖事件的几率降低有关。不管他们是否开了复方药。
