目的是根据一般实践数据库中2型糖尿病患者的处方数据比较处方和计算的每日胰岛素剂量。
共分析了17782名2型糖尿病患者(年龄:70.0±11.5岁;52%的男性;16%的糖尿病专家护理),来自834个实践(疾病分析仪:2011年01月12日)。对于短效药,计算处方日剂量(PDD)(医师文件)和计算日剂量(CDD)(包装尺寸×强度×体积/2个处方之间的天数)。长效,和预混合的胰岛素。使用配对t检验比较PDD和CDD。线性回归模型评估了胰岛素剂量差异(CDD-PDD)与年龄,性别,糖尿病专家护理,私人医疗保险,肥胖,HbA1c,高血压,高脂血症,大血管和微血管并发症。
短效的平均[SD]CDDs高于PDDs(52[28]vs48[26]单位/天),长效(30[20]vs24[15]单位/天),和预混合(46[26]vs40[21]单位/天)胰岛素(所有P<0.05)。在回归模型中,年龄(每年)与较高的CDD-PDD差异(+0.11,+0.04,+0.10;P<0.01)相关,长效,和预混合的胰岛素,分别。糖尿病专家的护理与较低的差异有关(-2.92,-1.02,-3.65;所有P<0.05)。HbA1c与长效胰岛素和预混合胰岛素的较高差异相关,但与短效胰岛素的差异较低有关(所有P<0.05)。
初级保健数据库研究中的CDD大大高估了PDD(8-25%)。年龄,糖尿病专家护理,血糖控制与CDD-PDD差异相关。用笔打底和安全射击,剂量错误,或者患者积累胰岛素储备可能是根本原因。
The aim was to compare the prescribed and calculated daily insulin dosages based on prescription data in type 2 diabetes patients in a general practice database.
A total of 17 782 type 2 diabetes patients (age: 70.0 ± 11.5 years; 52% males; 16% diabetologist care) with ≥2 insulin prescriptions from 834 practices were analyzed (Disease Analyser: 01/2011-12/2015). Prescribed daily dosage (PDD) (physician documentation) and calculated daily dose (CDD) (pack size × strength × volume / days between 2 prescriptions) were calculated for short-acting, long-acting, and premixed insulins. PDD and CDD were compared using paired t-tests. Linear regression models assessed the associations of insulin dosage difference (CDD-PDD) with age, sex, diabetologist care, private health insurance, obesity, HbA1c, hypertension, hyperlipidemia, macro- and microvascular complications.
Mean [SD] CDDs were higher than PDDs for short-acting (52 [28] vs 48 [26] units/day), long-acting (30 [20] vs 24 [15] units/day), and premixed (46 [26] vs 40 [21] units/day) insulins (all P < .05). In regression models, age (per year) was associated with higher CDD-PDD differences (+0.11, +0.04, +0.10; P < .01) for short-, long-acting, and premixed insulins, respectively. Diabetologist care was related to lower differences (-2.92, -1.02, -3.65; all P < .05). HbA1c was associated with higher differences in long-acting and premixed insulins, but was related to a lower difference in short-acting insulins (all P < .05).
CDD in primary care database studies substantially overestimate the PDD (8-25%). Age, diabetologist care, and glycemic control were related to CDD-PDD differences. Priming and safety shots with pens, dosing errors, or the accumulation of insulin reserves by patients may be underlying reasons.