IMS HEALTH, Frankfurt, Germany.
Prim Care Diabetes. 2013 Jul;7(2):167-71. doi: 10.1016/j.pcd.2013.02.001. Epub 2013 Mar 9.
To investigate if micro- and macrovascular co-morbidity has an influence on the time to insulin initiation in type 2 diabetes patients.
Longitudinal data from general practices in Germany, France and UK (Disease Analyzer) from 1995 to 2009 were analyzed, including 44,440 patients in Germany, 10,148 patients in France, and 25,499 patients in UK with newly diagnosed diabetes (index date). Cox regression was used to investigate the association of newly diagnosed micro- and macrovascular complications (ICD-10) on the time to insulin initiation adjusting for age, sex, antidiabetic therapy, and co-morbidity (hypertension, lipid disorders).
Insulin treatment was started in 9747 (22%) patients in Germany within 10 years after index date (France: n=702, 7%; UK: 3936, 14%). In all three countries, occurrence of microvascular complications was significantly associated with a higher likelihood to have insulin initiated (hazard ratio (HR), 95%CI: neuropathy: Germany 1.6; 1.5-1.8; France: 2.1; 1.1-3.9; UK: 1.5; 1.3-1.9; nephropathy: Germany 1.4; 1.3-1.6; France: 2.7; 1.4-3.8; UK: 1.2; 1.1-1.3). Among macrovascular complications, only coronary heart disease was related to insulin initiation in all three countries (Germany 1.2; 1.1-1.3; France: 1.5; 1.2-2.0; UK: 1.5; 1.3-1.7).
A more rapid progression to insulin therapy was found in patients with microvascular complications.
研究 2 型糖尿病患者微血管和大血管合并症是否会影响胰岛素起始时间。
分析了德国、法国和英国的普通实践中的纵向数据（疾病分析器），这些数据来自 1995 年至 2009 年，包括德国的 44440 名患者、法国的 10148 名患者和英国的 25499 名新诊断糖尿病患者（索引日期）。使用 Cox 回归分析新诊断的微血管和大血管并发症（ICD-10）对调整年龄、性别、抗糖尿病治疗和合并症（高血压、血脂紊乱）后胰岛素起始时间的关联。
在索引日期后 10 年内，德国有 9747 名（22%）患者开始胰岛素治疗（法国：n=702，7%；英国：3936，14%）。在所有三个国家，微血管并发症的发生与更有可能开始胰岛素治疗显著相关（风险比（HR），95%置信区间：神经病：德国 1.6；1.5-1.8；法国：2.1；1.1-3.9；英国：1.5；1.3-1.9；肾病：德国 1.4；1.3-1.6；法国：2.7；1.4-3.8；英国：1.2；1.1-1.3）。在大血管并发症中，只有冠心病与所有三个国家的胰岛素起始相关（德国 1.2；1.1-1.3；法国：1.5；1.2-2.0；英国：1.5；1.3-1.7）。
微血管并发症患者胰岛素治疗的进展更快。
