法国 ADHOC 调查：2 型糖尿病患者的当前胰岛素治疗情况。

Current insulin therapy in patients with type 2 diabetes: results of the ADHOC survey in France.

机构信息

Department of Endocrinology-Metabolism and Diabetology-Nutrition, University Hospital of Besançon, EA 3920, University Franche-Comté, 25000 Besançon, France.

出版信息

Diabetes Metab. 2011 Nov;37(5):440-5. doi: 10.1016/j.diabet.2011.03.001. Epub 2011 Apr 13.

DOI:10.1016/j.diabet.2011.03.001

PMID:21493117

Abstract

AIM

In France, the Afssaps/HAS 2006 guidelines for insulin-treated type 2 diabetic patients recommend a target glycated haemoglobin level (HbA(1c)) of less than 7%, achieved by optimalizing the insulin dose or increasing the number of daily injections. The present study investigated to what extent these recommendations are followed in clinical practice by general practitioners (GPs) and diabetologists (DTs).

METHODS

The ADHOC study (observational, transversal) was a survey of 267 GPs and 180 DTs prescribing insulin in France (participation rate: 4.45% and 11.6% of GPs and DTs, respectively). Physicians answered a questionnaire focused on aspects of insulin therapy in type 2 diabetic patients receiving oral antidiabetic drugs (OADs) and insulin for at least six months.

RESULTS

A total of 1874 patients were included in the study (959 from GPs and 915 from DTs). Insulin was initiated about 10 years after the diagnosis of diabetes, when patients had high HbA(1c) levels (mean value: 9.2%). At the time of the survey, patients had been treated with insulin for 3.4 ± 3.5 years (mean ± SD), and the mean HbA(1c) was significantly reduced (P<0.05) to 7.8% and 7.9% in patients treated by GPs and DTs, respectively. However, almost 80% of patients had HbA(1c) levels greater than 7%, and 35% had levels greater than 8%. The last fasting blood glucose level was 144 ± 45 mg/dL. More than 60% of patients with HbA(1c) greater than 8% were using single daily injection therapy. On consultation day, insulin treatment (dose, number of injections and type of insulin) was not optimalized in more than 40% of the latter patients. Differences in data between patients treated by GPs and DTs were small and often not statistically significant.

CONCLUSION

In this study, the main therapeutic goals of insulin therapy, as defined by the Afssaps/HAS 2006 guidelines, were only attained in around 20% of type 2 diabetic patients, irrespective of follow-up by a GP or DT. During consultation, insulin therapy was not optimalized in a large proportion of inadequately controlled patients.

摘要

目的

在法国， Afssaps/HAS 2006 年针对胰岛素治疗 2 型糖尿病患者的指南建议，糖化血红蛋白（HbA1c）的目标值应低于 7%，可通过优化胰岛素剂量或增加每日注射次数来实现。本研究旨在调查法国的全科医生（GP）和糖尿病专家（DT）在临床实践中对这些建议的遵循程度。

方法

ADHOC 研究（观察性、横断面研究）调查了在法国使用胰岛素治疗的 267 名 GP 和 180 名 DT，他们分别参与的比例为 4.45%和 11.6%。医生回答了一份问卷，重点关注接受口服降糖药（OAD）和胰岛素治疗至少 6 个月的 2 型糖尿病患者的胰岛素治疗方面。

结果

共纳入 1874 名患者（959 名来自 GP，915 名来自 DT）。胰岛素起始治疗大约在糖尿病诊断后 10 年，当时患者的 HbA1c 水平较高（平均值：9.2%）。在调查时，患者接受胰岛素治疗的时间为 3.4±3.5 年（平均值±标准差），GP 和 DT 治疗的患者的 HbA1c 平均值显著降低（P<0.05），分别为 7.8%和 7.9%。然而，近 80%的患者 HbA1c 水平大于 7%，35%的患者 HbA1c 水平大于 8%。最后一次空腹血糖水平为 144±45mg/dL。HbA1c 大于 8%的患者中，超过 60%使用每日单次注射治疗。在咨询日，HbA1c 大于 8%的患者中，超过 40%的患者胰岛素治疗（剂量、注射次数和胰岛素类型）未得到优化。GP 和 DT 治疗的患者数据之间的差异较小，且通常无统计学意义。