Tamayo Teresa, Claessen Heiner, Rückert Ina-Maria, Maier Werner, Schunk Michaela, Meisinger Christine, Mielck Andreas, Holle Rolf, Thorand Barbara, Narres Maria, Moebus Susanne, Mahabadi Amir-Abbas, Pundt Noreen, Krone Bastian, Slomiany Uta, Erbel Raimund, Jöckel Karl-Heinz, Rathmann Wolfgang, Icks Andrea
Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany.
Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
PLoS One. 2014 Jun 10;9(6):e99773. doi: 10.1371/journal.pone.0099773. eCollection 2014.
Diabetes treatment may differ by region and patients' socioeconomic position. This may be particularly true for newer drugs. However, data are highly limited.
We examined pooled individual data of two population-based German studies, KORA F4 (Cooperative Health Research in the Region of Augsburg, south), and the HNR (Heinz Nixdorf Recall study, west) both carried out 2006 to 2008. To ascertain the association between region and educational level with anti-hyperglycemic medication we fitted poisson regression models with robust error variance for any and newer anti-hyperglycemic medication, adjusting for age, sex, diabetes duration, BMI, cardiovascular disease, lifestyle, and insurance status.
The examined sample comprised 662 participants with self-reported type 2 diabetes (KORA F4: 83 women, 111 men; HNR: 183 women, 285 men). The probability to receive any anti-hyperglycemic drug as well as to be treated with newer anti-hyperglycemic drugs such as insulin analogues, thiazolidinediones, or glinides was significantly increased in southern compared to western Germany (prevalence ratio (PR); 95% CI: 1.12; 1.02-1.22, 1.52;1.10-2.11 respectively). Individuals with lower educational level tended to receive anti-hyperglycemic drugs more likely than their better educated counterparts (PR; 95% CI univariable: 1.10; 0.99-1.22; fully adjusted: 1.10; 0.98-1.23). In contrast, lower education was associated with a lower estimated probability to receive newer drugs among those with any anti-hyperglycemic drugs (PR low vs. high education: 0.66; 0.48-0.91; fully adjusted: 0.68; 0.47-0.996).
We found regional and individual social disparities in overall and newer anti-hyperglycemic medication which were not explained by other confounders. Further research is needed.
糖尿病治疗可能因地区和患者的社会经济地位而有所不同。对于新药而言，情况可能尤其如此。然而，相关数据极为有限。
我们对两项基于人群的德国研究的汇总个体数据进行了分析，这两项研究分别是2006年至2008年开展的奥格斯堡地区合作健康研究（KORA F4，位于南部）和海因茨·尼克斯多夫召回研究（HNR，位于西部）。为确定地区和教育水平与降糖药物之间的关联，我们针对所有降糖药物以及新药拟合了具有稳健误差方差的泊松回归模型，并对年龄、性别、糖尿病病程、体重指数、心血管疾病、生活方式和保险状况进行了调整。
所研究的样本包括662名自我报告患有2型糖尿病的参与者（KORA F4：83名女性，111名男性；HNR：183名女性，285名男性）。与德国西部相比，德国南部使用任何降糖药物以及使用胰岛素类似物、噻唑烷二酮类药物或格列奈类等新药进行治疗的概率显著增加（患病率比值（PR）；95%置信区间：分别为1.12；1.02 - 1.22，1.52；1.10 - 2.11）。教育水平较低的个体比受教育程度较高的个体更有可能使用降糖药物（PR；95%置信区间单变量：1.10；0.99 - 1.22；完全调整后：1.10；0.98 - 1.23）。相比之下，在所有使用降糖药物的人群中，教育水平较低与使用新药的估计概率较低相关（低教育水平与高教育水平的PR：0.66；0.48 - 0.91；完全调整后：0.68；0.47 - 0.996）。
我们发现总体和新型降糖药物的使用存在地区和个体社会差异，而其他混杂因素无法解释这些差异。需要进一步开展研究。
