Tamir Orly, Wainstein Julio, Raz Itamar, Shemer Joshua, Heymann Anthony
Israel Center for Technology Assessment in Health Care, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel.
Rev Diabet Stud. 2012 Spring;9(1):46-54. doi: 10.1900/RDS.2012.9.46. Epub 2012 May 10.
Clinical evidence points to patient-perceived difficulties and compliance problems in implementing early insulin therapy. Therefore, individual treatment aims are necessary to optimize diabetes therapy, as currently acknowledged by the new ADA/EASD guidelines. Better characterization of patient-perceived difficulties in the implementation of early insulin treatment may contribute to improved compliance and optimal tailoring of treatment regimens for the individual patient.
To assess differences in quality of life (QoL) and patient-perceived difficulties in health care with every addition of oral hypoglycemic agents (OHAs) and insulin therapy.
The analysis was conducted on a cross-sectional sample of 714 diabetic patients treated with OHAs or with insulin once or twice daily. Differences in diabetes-specific QoL, overall QoL, and perception of difficulties associated with specific diabetes treatment attributes were evaluated using trend analysis and comparisons between groups. The contribution of each diabetes treatment attribute to QoL measures and glycemic control was also assessed.
No significant differences were found in QoL measures among patients treated exclusively with OHAs when these patients were assessed by the number of oral agents, irrespective of the degree of glycemic control. Better controlled patients treated with 2 OHAs, compared with poorly controlled patients treated with a single OHA, had a lower perception of difficulties associated with diabetes treatment attributes. Poorly controlled patients treated with 2 OHAs and better controlled patients treated with 3 OHAs had similar QoL and perceived difficulties with care. However, the insulin-based alternative was consistently associated with a significantly higher perception of pain and lower overall QoL when compared with the oral regimens. Multivariate models accounted for 52% and 32% of the variance in QoL measures.
From the patients' perspective, oral therapy is the preferred strategy for attaining the treatment goals since the addition of OHAs was not associated with lower QoL or patient-perceived difficulties with care. If early insulin treatment is considered, physicians should address specific diabetes treatment characteristics, mainly the issue of pain, to promote improved QoL and disease control.
临床证据表明，患者在实施早期胰岛素治疗时存在自我感知的困难和依从性问题。因此，如美国糖尿病协会（ADA）/欧洲糖尿病研究协会（EASD）新指南目前所认可的，制定个体化治疗目标对于优化糖尿病治疗十分必要。更好地描述患者在实施早期胰岛素治疗时所感知的困难，可能有助于提高依从性，并为个体患者优化治疗方案。
评估每次增加口服降糖药（OHA）和胰岛素治疗时，患者的生活质量（QoL）差异以及患者在医疗保健方面自我感知的困难。
对714例接受OHA治疗或每日接受一次或两次胰岛素治疗的糖尿病患者的横断面样本进行分析。使用趋势分析和组间比较，评估糖尿病特异性QoL、总体QoL以及与特定糖尿病治疗属性相关的困难感知方面的差异。还评估了每种糖尿病治疗属性对QoL测量和血糖控制的贡献。
仅接受OHA治疗的患者，无论血糖控制程度如何，根据口服药物数量评估时，QoL测量结果无显著差异。与使用单一OHA治疗的血糖控制不佳的患者相比，使用两种OHA治疗的血糖控制较好的患者对糖尿病治疗属性相关困难的感知较低。使用两种OHA治疗的血糖控制不佳的患者和使用三种OHA治疗的血糖控制较好的患者具有相似的QoL和护理困难感知。然而，与口服治疗方案相比，基于胰岛素的替代方案始终与更高的疼痛感知和更低的总体QoL相关。多变量模型解释了QoL测量中52%和32%的方差。
从患者的角度来看，口服治疗是实现治疗目标的首选策略，因为增加OHA与较低的QoL或患者感知的护理困难无关。如果考虑早期胰岛素治疗，医生应关注特定的糖尿病治疗特征，主要是疼痛问题，以促进QoL的改善和疾病控制。
