Kostev Karel, Rockel Timo, Rosenbauer Joachim, Rathmann Wolfgang
IMS HEALTH, D-60598 Frankfurt/Main, Germany.
IMS HEALTH, D-60598 Frankfurt/Main, Germany.
Prim Care Diabetes. 2014 Dec;8(4):346-51. doi: 10.1016/j.pcd.2014.03.006. Epub 2014 Apr 13.
Previous studies have shown that only a small number of pediatric and young adult patients discontinue pump therapy, but risk factors for discontinuation are unclear.
To identify characteristics of pediatric and young adult patients with pump therapy which are associated with discontinuation of treatment.
Retrospective cohort study using a representative nationwide database (LRx; IMS Health) in Germany covering >80% of all prescriptions to members of statutory health insurances in 2008-2011. All patients (age group <25 years) with new prescriptions of insulin pumps were identified (2009-2010) and were followed for 12 months.
Overall, 2452 new pump users were identified, of whom 177 (7.2%) switched to other forms of insulin therapy within 12 months. In multivariate logistic regression, younger age (<6 years; reference 18 to <25 years: Odds ratio, OR, 95% CI: 0.36; 0.17-0.74) and use of teflon needles (reference steel needles: OR, 95% CI: 0.59; 0.41-0.83) were related to a lower odds of pump discontinuation. A non-significant trend was found for male sex (OR, 95% CI: 0.75; 0.52-1.08). Prescriptions of thyroid therapeutics (ATC H03A: OR, 95% CI: 1.79; 1.23-2.61) and antiepileptics (N03: OR, 95% CI: 3.14; 1.49-6.59) were significantly associated with discontinuation of pump therapy.
About 93% of pediatric and young adult patients maintained insulin pump therapy within 12 months. Age <6 years, male sex and teflon needle use were associated with a lower risk of discontinuation. Thyroid therapy (indicating autoimmunity) and antiepileptic drug prescriptions were associated with a higher likelihood for discontinuation of insulin pump treatment.
既往研究表明，仅有少数儿科和青年成年患者停止泵治疗，但停止治疗的危险因素尚不清楚。
确定与停止泵治疗相关的儿科和青年成年泵治疗患者的特征。
采用德国一个具有代表性的全国性数据库（LRx；艾美仕市场研究公司）进行回顾性队列研究，该数据库涵盖了2008 - 2011年法定医疗保险成员超过80%的所有处方。确定所有新开具胰岛素泵处方的患者（年龄组<25岁）（2009 - 2010年），并随访12个月。
总体而言，共确定了2452名新的泵使用者，其中177名（7.2%）在12个月内改用其他形式的胰岛素治疗。在多因素逻辑回归分析中，年龄较小（<6岁；参照18至<25岁：比值比，OR，95%置信区间：0.36；0.17 - 0.74）以及使用聚四氟乙烯针头（参照钢针：OR，95%置信区间：0.59；0.41 - 0.83）与停止泵治疗的较低几率相关。男性存在不显著的趋势（OR，95%置信区间：0.75；0.52 - 1.08）。甲状腺治疗药物处方（解剖治疗学化学分类系统H03A：OR，95%置信区间：1.79；1.23 - 2.61）和抗癫痫药（N03：OR，95%置信区间：3.14；1.49 - 6.59）与泵治疗的停止显著相关。
约93%的儿科和青年成年患者在12个月内维持胰岛素泵治疗。年龄<6岁、男性以及使用聚四氟乙烯针头与较低的停止治疗风险相关。甲状腺治疗（提示自身免疫）和抗癫痫药物处方与胰岛素泵治疗停止的较高可能性相关。
