Marrero D G, Moore P S, Fineberg N S, Langefeld C D, Clark C M
Indiana University School of Medicine, Indianapolis 46202.
J Community Health. 1991 Oct;16(5):259-67. doi: 10.1007/BF01320334.
The extent to which a sample of community based, primary care physicians follow current standards of care for the treatment of non-obese, insulin-requiring patients as defined and recently published by the American Diabetes Association (ADA) was studied. A total of 212 physicians responded with 191 indicating that they treat one or more non-obese, insulin-requiring patients. Of this sample, 97% used multiple injection, mixed insulin regimens. However, over 70% also used single injection regimens. Whereas 94% prescribed self-monitoring blood glucose (SMBG), only 31% did so for more than 75% of their patients and 37% did so for less than 50%. Twenty-five percent of respondents did not obtain HbA1 values on their patients. For respondents who do collect HbA1, only 28% did so for over 75% of their patients and 30% for less than 50%. Physicians with fewer patients were more likely to prescribe single injection insulin regimens (P = .02). Recent graduates from medical school also used HbA1's more frequently than earlier graduates (p = .001). These data suggest that while care practices recommended by the ADA are being implemented by primary care physicians, they are significantly underutilized.
研究了一组以社区为基础的初级保健医生对美国糖尿病协会（ADA）定义并于近期发布的非肥胖、需要胰岛素治疗患者的当前治疗标准的遵循程度。共有212名医生做出回应，其中191名表示他们治疗一名或多名非肥胖、需要胰岛素治疗的患者。在这个样本中，97%的医生使用多次注射、混合胰岛素治疗方案。然而，超过70%的医生也使用单次注射治疗方案。虽然94%的医生开了自我血糖监测（SMBG）的医嘱，但只有31%的医生对超过75%的患者进行了此项医嘱，37%的医生对不到50%的患者进行了此项医嘱。25%的受访者没有获取其患者的糖化血红蛋白（HbA1）值。对于确实收集了HbA1的受访者，只有28%的医生对超过75%的患者进行了此项操作，30%的医生对不到50%的患者进行了此项操作。患者较少的医生更有可能开具单次注射胰岛素治疗方案（P = 0.02）。医学院的应届毕业生也比早期毕业生更频繁地使用HbA1（p = 0.001）。这些数据表明，虽然初级保健医生正在实施ADA推荐的护理措施，但这些措施的利用率明显不足。
