Cramer Joyce A
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
Diabetes Care. 2004 May;27(5):1218-24. doi: 10.2337/diacare.27.5.1218.
The purpose of this study was to determine the extent to which patients omit doses of medications prescribed for diabetes.
A literature search (1966-2003) was performed to identify reports with quantitative data on adherence with oral hypoglycemic agents (OHAs) and insulin and correlations between adherence rates and glycemic control. Adequate documentation of adherence was found in 15 retrospective studies of OHA prescription refill rates, 5 prospective electronic monitoring OHA studies, and 3 retrospective insulin studies.
Retrospective analyses showed that adherence to OHA therapy ranged from 36 to 93% in patients remaining on treatment for 6-24 months. Prospective electronic monitoring studies documented that patients took 67-85% of OHA doses as prescribed. Electronic monitoring identified poor compliers for interventions that improved adherence (61-79%; P < 0.05). Young patients filled prescriptions for one-third of prescribed insulin doses. Insulin adherence among patients with type 2 diabetes was 62-64%.
This review confirms that many patients for whom diabetes medication was prescribed were poor compliers with treatment, including both OHAs and insulin. However, electronic monitoring systems were useful in improving adherence for individual patients. Similar electronic monitoring systems for insulin administration could help healthcare providers determine patients needing additional support.
本研究旨在确定糖尿病患者漏服处方药物的程度。
进行文献检索（1966 - 2003年），以找出有关口服降糖药（OHAs）和胰岛素依从性的定量数据报告以及依从率与血糖控制之间的相关性。在15项关于OHA处方 refill率的回顾性研究、5项前瞻性电子监测OHA研究和3项回顾性胰岛素研究中发现了足够的依从性记录。
回顾性分析表明，持续治疗6 - 24个月的患者中，OHA治疗的依从率在36%至93%之间。前瞻性电子监测研究记录显示，患者按规定服用了67% - 85%的OHA剂量。电子监测识别出依从性差的患者，针对这些患者采取的干预措施可提高依从性（61% - 79%；P < 0.05）。年轻患者仅服用了规定胰岛素剂量的三分之一。2型糖尿病患者的胰岛素依从性为62% - 64%。
本综述证实，许多开了糖尿病药物处方的患者对治疗依从性差，包括OHAs和胰岛素。然而，电子监测系统有助于提高个体患者的依从性。类似的胰岛素给药电子监测系统可帮助医疗服务提供者确定需要额外支持的患者。
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