Hauber A B, Mohamed A F, Johnson F R, Falvey H
RTI Health Solutions, Research Triangle Park, NC, USA.
Diabet Med. 2009 Apr;26(4):416-24. doi: 10.1111/j.1464-5491.2009.02696.x.
Medication non-adherence is particularly common in patients with Type 2 diabetes. We constructed a discrete-choice experiment to examine the relative importance of oral glucose-lowering medication features and to estimate the likely effect of effectiveness and side effects on medication adherence in patients with Type 2 diabetes in the UK and the USA.
Preferences were elicited using a cross-sectional, web-enabled survey. Patients with a self-reported physician-made diagnosis of Type 2 diabetes, who were currently taking oral glucose-lowering medications were recruited through an existing online chronic-disease panel. In each discrete-choice question, patients were asked to choose between two hypothetical medication alternatives, each defined by improvement in glycated haemoglobin, frequency of mild-to-moderate hypoglycaemia, water retention, weight gain, mild stomach upset and medication-related cardiovascular risk. Patients were also asked to indicate how likely they would be to miss or skip doses of each hypothetical medication.
Two hundred and four patients in the UK and 203 patients in the USA completed the survey. Preferences did not differ between the two countries. Overall, glucose control was the most important medication feature, followed by medication-related cardiovascular risk and weight gain, respectively. Water retention was not important to patients. Weight gain and cardiovascular risk had significant negative effects on likely medication adherence.
While patients with Type 2 diabetes believe glucose control is important, medication side effects and risks influence patients' treatment choices. Medication-related weight gain and cardiovascular risk are significant predictors of likely medication non-adherence.
药物治疗依从性差在2型糖尿病患者中尤为常见。我们构建了一项离散选择实验，以研究口服降糖药物特征的相对重要性，并估计疗效和副作用对英国和美国2型糖尿病患者药物治疗依从性的可能影响。
通过一项横断面的、基于网络的调查来获取偏好。通过现有的在线慢性病小组招募那些自我报告经医生诊断为2型糖尿病且正在服用口服降糖药物的患者。在每个离散选择问题中，要求患者在两种假设的药物选择之间进行抉择，每种选择由糖化血红蛋白的改善情况、轻度至中度低血糖的发生频率、水潴留、体重增加、轻度胃部不适以及药物相关心血管风险来定义。还要求患者指出他们错过或漏服每种假设药物剂量的可能性。
英国的204名患者和美国的203名患者完成了调查。两国患者的偏好没有差异。总体而言，血糖控制是最重要的药物特征，其次分别是药物相关心血管风险和体重增加。水潴留对患者而言并不重要。体重增加和心血管风险对可能的药物治疗依从性有显著的负面影响。
虽然2型糖尿病患者认为血糖控制很重要，但药物副作用和风险会影响患者的治疗选择。药物相关的体重增加和心血管风险是可能导致药物治疗依从性差的重要预测因素。
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