The Brod Group, Mill Valley, CA 94941, USA.
Curr Med Res Opin. 2012 Dec;28(12):1947-58. doi: 10.1185/03007995.2012.743457. Epub 2012 Nov 14.
The objectives were to estimate the prevalence of self-treated hypoglycaemia in patients using basal insulin analogues; identify demographic, treatment related and behavioural risk factors; and describe patient and physician responses to these events.
The GAPP2 (Global Attitude of Patients and Physicians 2) study was an online multinational cross-sectional study of patients with type 2 diabetes currently treated with basal insulin, and healthcare professionals involved in the care of such patients. The primary variable of interest was self-treated hypoglycaemia within the last 30 days.
A total of 3042 patients treated with basal insulin analogues and 1222 prescribers completed the full survey. Overall, 36% of patients had experienced self-treated hypoglycaemia during the previous 30 days. In response to self-treated hypoglycaemia, patients reported missing (7%), reducing (11%) or mistiming (4%) basal insulin doses, increasing the level of glucose monitoring (40%) or utilising healthcare resources (7%). Patients reporting irregular basal insulin dosing by missing, mistiming or reducing a dose were also significantly more likely to report an episode of self-treated hypoglycaemia in the same time period: 41% versus 34% (p = 0.004), 43% versus 33% (p < 0.001), and 56% versus 32% (p < 0.001) respectively. Nocturnal events worried significantly more patients than diurnal events (42% versus 23%, p < 0.001). Patient worry about hypoglycaemia, insulin regimen and reduced basal dosing were identified as the key differentiating variables associated with increased risk of self-treated hypoglycaemic events. Most prescribers (76%) believed that insulin analogues minimised the risk of nocturnal hypoglycaemia when compared to NPH insulin; 46% also reported being contacted at least once a month by insulin analogue patients after self-treated hypoglycaemic events.
Self-treated hypoglycaemia is common in approximately one third of patients using insulin analogue regimens. Additionally, self-treated hypoglycaemia was found to be associated with clinically significant effects on patient well-being and functioning, patient and physician management and healthcare utilisation despite the potential limitations of an online self-complete survey such as the need to be topic focused, the potential for under-reporting and social bias.
评估使用基础胰岛素类似物的患者中自我治疗低血糖的发生率；确定人口统计学、治疗相关和行为风险因素；并描述患者和医生对这些事件的反应。
GAPP2（全球患者和医生态度 2 期）研究是一项针对正在接受基础胰岛素治疗的 2 型糖尿病患者和参与此类患者治疗的医疗保健专业人员的在线多国横断面研究。主要关注的变量是过去 30 天内的自我治疗低血糖。
共有 3042 名使用基础胰岛素类似物的患者和 1222 名处方医生完成了完整的调查。总体而言，36%的患者在过去 30 天内经历过自我治疗低血糖。作为对自我治疗低血糖的反应，患者报告漏用（7%）、减少（11%）或错用（4%）基础胰岛素剂量，增加血糖监测水平（40%）或利用医疗保健资源（7%）。报告不规则基础胰岛素剂量的患者，即漏用、错用或减少剂量，在同一时期报告自我治疗低血糖发作的可能性也显著更高：41%比 34%（p=0.004）、43%比 33%（p<0.001）和 56%比 32%（p<0.001）。夜间事件令患者明显比日间事件更担忧（42%比 23%，p<0.001）。患者对低血糖的担忧、胰岛素方案和基础剂量减少被确定为与自我治疗低血糖事件风险增加相关的关键区别变量。大多数医生（76%）认为与 NPH 胰岛素相比，胰岛素类似物可降低夜间低血糖的风险；46%的医生还报告说，在自我治疗低血糖后，每月至少有一次被胰岛素类似物患者联系。
使用胰岛素类似物治疗的患者中，约有三分之一发生自我治疗低血糖。此外，尽管在线自我完成调查存在需要关注特定主题、潜在漏报和社会偏见等潜在局限性，但自我治疗低血糖与患者的健康状况和功能、患者和医生的管理以及医疗保健的利用具有显著相关的临床影响。
