Norkus Antanas, Ostrauskas Rytas, Zalinkevičius Rimantas, Radzevičienė Lina, Sulcaite Rita
Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Patient Prefer Adherence. 2013 Jul 8;7:643-52. doi: 10.2147/PPA.S45867. Print 2013.
Patients with diabetes mellitus in Lithuania have access to almost all the latest blood glucose-lowering drugs available in the rest of the world. This study evaluated the effects of prescribing of treatment (oral medications, insulin, or both) in Lithuanian patients with type 1 or 2 diabetes and poor blood glucose control.
The relevant information was obtained from specialized questionnaires completed by 26 consulting endocrinologists in Lithuania between October 1, 2008 and December 31, 2008. The study cohort comprised 865 randomly selected patients with diabetes mellitus and a glycosylated (HbA1c) level ≥7%. In total, there were 95 patients with type 1 diabetes and 770 with type 2 diabetes.
Linear regression for patients with type 1 diabetes revealed a weak trend towards higher doses of insulin reflecting lower HbA1c values. The mean dose of insulin in patients with type 1 diabetes before an endocrinology consultation was 57.1 ± 15.7 U/day (0.8 ± 0.2 U/kg), which increased significantly to 63.3 ± 16.5 U/day (0.9 ± 0.2 U/kg) after an endocrinology consultation (P < 0.05). Treatment prescribed for patients with type 2 diabetes depended on the duration of disease. Earlier treatment recommended for 68% of patients with type 2 diabetes was subsequently changed by the endocrinologist. Linear regression showed that the insulin dose prescribed before a specialist consultation as well as that recommended by an endocrinologist was significantly correlated with body mass index.
Appropriate prescribing of blood glucose-lowering drugs does not always translate into good metabolic control of diabetes mellitus. The mean HbA1c was 8.5% ± 1.3% in patients with type 2 diabetes treated with oral drugs alone versus 9.0% ± 1.3% in those treated with insulin alone.
立陶宛的糖尿病患者能够使用世界其他地区几乎所有最新的降血糖药物。本研究评估了立陶宛1型或2型糖尿病且血糖控制不佳患者的治疗处方（口服药物、胰岛素或两者皆用）效果。
相关信息来自2008年10月1日至2008年12月31日期间立陶宛26位内分泌科会诊医生填写的专门问卷。研究队列包括865名随机选取的糖化血红蛋白（HbA1c）水平≥7%的糖尿病患者。其中，1型糖尿病患者95例，2型糖尿病患者770例。
1型糖尿病患者的线性回归显示，胰岛素剂量越高，糖化血红蛋白值越低，但趋势较弱。内分泌科会诊前，1型糖尿病患者的胰岛素平均剂量为57.1±15.7 U/天（0.8±0.2 U/千克），会诊后显著增加至63.3±16.5 U/天（0.9±0.2 U/千克）（P<0.05）。2型糖尿病患者的治疗处方取决于病程。内分泌科医生随后改变了对68%的2型糖尿病患者早期推荐的治疗方案。线性回归表明，专科会诊前开具的胰岛素剂量以及内分泌科医生推荐的剂量均与体重指数显著相关。
适当开具降血糖药物并不总能转化为良好的糖尿病代谢控制。仅接受口服药物治疗的2型糖尿病患者的平均糖化血红蛋白为8.5%±1.3%，而仅接受胰岛素治疗的患者为9.0%±1.3%。
