Department of Cardiovascular Sciences, University of Leicester, UK.
Diabet Med. 2013 May;30(5):512-24. doi: 10.1111/dme.12128.
To identify real-world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2 diabetes mellitus.
A literature search was conducted in PubMed and EMBASE in November 2011 to identify studies reporting factors associated with adherence/non-adherence to insulin therapy in adults with Type 1 or Type 2 diabetes.
Seventeen studies were identified; six used self-reported measures and 11 used calculated measures of adherence. Most (13/17) were conducted exclusively in the USA. Four categories of factors associated with non-adherence were identified: predictive factors for non-adherence, patient-perceived barriers to adherence, type of delivery device and cost of medication. For predictive factors and patient-perceived barriers, only age, female sex and travelling were associated with non-adherence in more than one study. Fear of injections and embarrassment of injecting in public were also cited as reasons for non-adherence. Conversely, adherence was improved by initiating therapy with, or switching to, a pen device (in four studies), and by changing to an insurance scheme that lowered the financial burden on patients (in two studies).
Adherence to insulin therapy is generally poor. Few factors or patient-perceived barriers were consistently identified as predictive for non-adherence, although findings collectively suggest that a more flexible regimen may improve adherence. Switching to a pen device and reducing patient co-payments appear to improve adherence. Further real-world studies are warranted, especially in countries other than the USA, to identify factors associated with non-adherence and enable development of strategies to improve adherence to insulin therapy.
确定影响 1 型或 2 型糖尿病患者胰岛素治疗依从性的真实世界因素。
2011 年 11 月，在 PubMed 和 EMBASE 中进行文献检索，以确定报告与 1 型或 2 型糖尿病成人患者依从性/不依从性相关因素的研究。
确定了 17 项研究；其中 6 项使用了自我报告的测量方法，11 项使用了计算得出的依从性测量方法。（这些研究）大多数（13/17）仅在美国进行。确定了与不依从相关的四类因素：不依从的预测因素、患者对依从性的感知障碍、给药装置类型和药物成本。对于预测因素和患者对依从性的感知障碍，只有年龄、女性和旅行在超过一项研究中与不依从相关。对注射的恐惧和在公共场合注射的尴尬也是不依从的原因。相反，通过起始治疗时使用笔式装置（在四项研究中）或切换到降低患者经济负担的保险计划（在两项研究中），可以改善依从性。
胰岛素治疗的依从性通常较差。尽管研究结果总体表明更灵活的治疗方案可能会提高依从性，但很少有因素或患者对依从性的感知障碍被一致确定为不依从的预测因素。改用笔式装置和降低患者自付额似乎可以提高依从性。需要进一步进行真实世界的研究，特别是在除美国以外的国家，以确定与不依从相关的因素，并制定改善胰岛素治疗依从性的策略。
