Munro N, Barnett A H
Department of Health Care Management and Policy, University of Surrey Chelsea and Westminster Hospital, London, UK.
Int J Clin Pract. 2014 Jun;68(6):692-9. doi: 10.1111/ijcp.12388. Epub 2014 Feb 18.
The Global Attitude of Patients and Physicians 2 (GAPP2) survey sought to address gaps in understanding about real-world basal insulin-taking behaviour and self-treated hypoglycaemia in patients with type 2 diabetes mellitus.
The Global Attitude of Patients and Physicians 2 was an international, online, cross-sectional study of patients aged at least 40 years with type 2 diabetes taking analogue insulins, and healthcare professionals (HCPs). Patients were recruited from general consumer online research panels, comprising a representative sample of the population to minimise bias. HCPs were recruited from online specialist research panels. The results of the UK cohort are presented here.
The UK cohort constituted 12% of the total GAPP2 population. In this cohort, 15-25% of patients reported that they had reduced, missed or mistimed at least one dose of insulin in the previous month. On the last occasion that patients had reduced a dose, 82% had done so intentionally - most frequently because of concerns about hypoglycaemia. HCP estimates of the numbers of patients with dosing irregularities were nearly fourfold higher than patient reports. More than one-third of HCPs believe their patients under-report the frequency of self-treated hypoglycaemia. Nevertheless, a proportion did not regularly discuss these concerns with their patients.
Healthcare professionals are in the best position to support patients in making appropriate insulin dose adjustments to help regularise blood glucose levels and reduce treatment-induced hypoglycaemic events. This can be achieved by initiating frequent discussions with all patients and providing education and training when appropriate.
“全球患者与医生态度2(GAPP2)”调查旨在解决2型糖尿病患者在实际使用基础胰岛素行为和自我治疗低血糖方面的认知差距。
“全球患者与医生态度2”是一项针对至少40岁、正在使用类似物胰岛素的2型糖尿病患者及医疗保健专业人员(HCPs)的国际性在线横断面研究。患者从一般消费者在线研究小组中招募,这些小组构成了具有代表性的人群样本,以尽量减少偏差。HCPs从在线专家研究小组中招募。本文展示了英国队列的结果。
英国队列占GAPP2总人群的12%。在该队列中,15% - 25%的患者报告称他们在前一个月至少有一次减少、漏服或错服胰岛素剂量。在患者最后一次减少剂量时,82%是故意这样做的——最常见的原因是担心低血糖。HCPs对剂量不规律患者数量的估计比患者报告高出近四倍。超过三分之一的HCPs认为他们的患者对自我治疗低血糖的频率报告不足。然而,有一部分HCPs没有定期与患者讨论这些问题。
医疗保健专业人员最有能力支持患者进行适当的胰岛素剂量调整,以帮助稳定血糖水平并减少治疗引起的低血糖事件。这可以通过与所有患者频繁展开讨论并在适当的时候提供教育和培训来实现。