我国糖尿病患病率居高不下,未来可能会发生更多由糖尿病引起的心脑血管不良事件。
从药师的角度分析目前的药物治疗管理与2型糖尿病住院患者指南的差距,为2型糖尿病患者优化药物治疗管理方法和模式提供参考。
本研究是一项横断面观察性研究。研究通过对降糖药物的使用情况进行调查分析,调整血压管理策略,脂质管理,体重管理,抗血小板药物在2型糖尿病住院患者中的应用。
共纳入1086例2型糖尿病患者。二甲双胍,糖苷酶抑制剂,基础胰岛素在2型糖尿病住院患者中使用最多。SGLT-2,GLP-1RAs,DPP-4和二甲双胍均显示显著增加。SGLT-2抑制剂(SGLT-2i)从2020年到2021年增长最快(14.5%vs.39.6%);然而,SGLT-2i在合并ASCVD患者中的应用率较低,肾功能不全,和糖尿病肾病(46.4%,40.9%,分别为45.8%)。对于入院时血压不达标的患者,内分泌科医生对住院期间调整降压方案的平均干预率为55.6%,ACEI/ARB药物应用率达64.4%。他汀类药物在2型糖尿病患者中的应用率仍较高,78.8%。然而,LDL-c欠佳患者的总体干预率仅为24.1%.ASCVD患者抗血小板药物的应用率为77.6%,高于无ASCVD患者。
中国住院2型糖尿病患者的药物治疗管理实践与指南还有差距,特别是GLP-1RAs和SGLT-2i在合并ASCVD患者中的应用,糖尿病肾病,和肾功能不全。同时,医师和药师应重视2型糖尿病患者的血压和LDL-c水平,并及时提供干预措施。
The prevalence of diabetes mellitus remains high in China, and more cardiovascular and cerebrovascular adverse events due to diabetes mellitus are likely to occur in the future.
To analyze the gap between the current pharmacotherapy management and the
guidelines for inpatients with type 2 diabetes mellitus from the perspective of pharmacists so as to provide a reference for optimal pharmacotherapy management methods and models for patients with type 2 diabetes mellitus.
The study was a cross-sectional observational study. The study was conducted by investigating and analyzing the use of glucose-lowering drugs, adjustment of blood pressure management strategy, lipid management, weight management, and application of antiplatelet drugs in type 2 diabetes inpatients.
A total of 1086 patients with type 2 diabetes were included. Metformin, glycosidase inhibitors, and basal insulin were the most used among type 2 diabetes inpatients. The use of SGLT-2, GLP-1 RAs, DPP-4, and metformin all showed significant increase. SGLT-2 inhibitors (SGLT-2i) showed the fastest increase from 2020 to 2021 (14.5% vs. 39.6%); However, the application rate of SGLT-2i was low among patients with combined ASCVD, renal insufficiency, and diabetic nephropathy (46.4%, 40.9%, and 45.8% respectively). For patients with substandard blood pressure at admission, the average rate of intervention by endocrinologists for adjusting the antihypertensive regimen during hospitalization was 55.6%, and the application rate of ACEI/ARB drugs reached 64.4%. The application rate of statins among patients with type 2 diabetes was still relatively high, at 78.8%. However, the overall intervention rate for patients with suboptimal LDL-c was only 24.1%. The application rate of antiplatelet agents for patients with ASCVD was 77.6%, which was higher than that for patients without ASCVD.
There is still a gap between the practice of medication treatment management of Chinese inpatients with type 2 diabetes and the
guidelines, especially in the application of GLP-1RAs and SGLT-2i in patients with concomitant ASCVD, diabetic nephropathy, and renal insufficiency. Meanwhile, physicians and pharmacists should pay more attention on achieving blood pressure and LDL-c standards in type 2 diabetic patients and provide timely interventions.