1995年至2003年糖尿病患者药物治疗方案及检查医嘱的复杂性。
The complexity of medication regimens and test ordering for patients with diabetes from 1995 to 2003.
作者信息
Huang Elbert S, Basu Anirban, Finch Michael, Frytak Jennifer, Manning Willard
机构信息
Section of General Internal Medicine, Pritzker School of Medicine, University of Chicago, IL 60637, USA.
出版信息
Curr Med Res Opin. 2007 Jun;23(6):1423-30. doi: 10.1185/030079907X199600. Epub 2007 May 14.
OBJECTIVE
Diabetes care has become increasingly complex. We set out to quantify recent trends in the complexity of medication regimens and test ordering for diabetes patients continuously enrolled in health plans affiliated with a large, regional US health maintenance organization, with representation in the South and Midwest.
RESEARCH DESIGN AND METHODS
We provide descriptive trends analysis of overall diabetes care complexity (number of components [i.e., glucose, blood pressure, cholesterol control], number of medications/tests) from 1995 to 2003 for adults with diabetes (N = 304,233).
MAIN OUTCOME MEASURES
The main outcomes were (1) the proportion of patients receiving diabetes-related medications (blood glucose, blood pressure, and cholesterol control agents), (2) the average number of medications, (3) the proportion of patients receiving diabetes-related tests (glycosylated hemoglobin [HbA1c], urine microalbumin, and serum cholesterol), (4) and the average number of tests ordered within the first year that a patient had any indication of diabetes.
RESULTS
The proportion of patients on cholesterol lowering drugs (18% --> 39%, p < 0.01) and blood pressure lowering drugs (51% --> 62%, p = 0.04) rose significantly, while the proportion on glucose lowering drugs fell (76% --> 47%, p < 0.01). Among patients prescribed medications, the average total number of diabetes-related medications rose from 2.96 to 3.70 medications (p < 0.01) with smaller increases seen for glucose lowering (1.45 --> 1.65, p < 0.01) and blood pressure lowering regimens (2.14 --> 2.51, p < 0.01), and no change for cholesterol lowering drugs (1.23 --> 1.19, p = 0.19). For laboratory tests, the proportion receiving cholesterol (40% --> 58%), and urine microalbumin (4% --> 18%) (all p's < 0.01) rose significantly, while the testing rates for HbA(1c) remained unchanged. The average total number of tests ordered per year increased significantly from 3.34 to 4.10 (p < 0.01) with more modest increases observed for individual tests.
LIMITATION
Trends analyses are unadjusted for many clinical characteristics that might influence the complexity of diabetes care.
CONCLUSIONS
Diabetes care grew more complex with the largest change in the number of patients receiving multi-component diabetes care. While the use of blood pressure and cholesterol lowering drugs rose overall, the proportion of patients using glucose lowering drugs declined and the average number of prescribed glucose lowering drugs did not increase in a clinically significant manner.
目的
糖尿病护理日益复杂。我们旨在量化持续参保于美国一家大型地区性健康维护组织旗下健康计划的糖尿病患者用药方案和检查项目的复杂性近期趋势，该组织业务覆盖美国南部和中西部地区。
研究设计与方法
我们对1995年至2003年期间成年糖尿病患者（N = 304,233）的总体糖尿病护理复杂性（组成部分数量[即血糖、血压、胆固醇控制]、药物/检查数量）进行描述性趋势分析。
主要结局指标
主要结局包括（1）接受糖尿病相关药物治疗的患者比例（血糖、血压和胆固醇控制药物），（2）平均用药数量，（3）接受糖尿病相关检查的患者比例（糖化血红蛋白[HbA1c]、尿微量白蛋白和血清胆固醇），（4）患者出现糖尿病迹象的第一年所开具检查的平均数量。
结果
服用降胆固醇药物的患者比例显著上升（18% → 39%，p < 0.01），服用降压药物的患者比例也显著上升（51% → 62%，p = 0.04），而服用降糖药物的患者比例下降（76% → 47%，p < 0.01）。在开具药物的患者中，糖尿病相关药物的平均总数从2.96种增至3.70种（p < 0.01），降糖药物（1.45 → 1.65，p < 0.01）和降压药物方案（2.14 → 2.51，p < 0.01）的增幅较小，而降胆固醇药物数量无变化（1.23 → 1.19，p = 0.19）。对于实验室检查，接受胆固醇检查的患者比例（40% → 58%）和尿微量白蛋白检查的患者比例（4% → 18%）（所有p值均 < 0.01）显著上升，而HbA(1c)的检查率保持不变。每年开具检查的平均总数从3.34项显著增至4.10项（p < 0.01），各项检查的增幅相对较小。
局限性
趋势分析未针对可能影响糖尿病护理复杂性的许多临床特征进行调整。
结论
糖尿病护理变得更加复杂，接受多成分糖尿病护理的患者数量变化最大。虽然总体上使用降压和降胆固醇药物的患者比例上升，但使用降糖药物的患者比例下降，且开具降糖药物的平均数量未出现具有临床意义的增加。
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