Wendel C S, Fotieo G G, Shah J H, Felicetta J, Curtis B H, Murata G H
Southern Arizona VA Health Care System and University of Arizona College of Medicine, Tucson, AZ, USA.
Diabet Med. 2014 Dec;31(12):1524-31. doi: 10.1111/dme.12543. Epub 2014 Jul 22.
To quantify the incidence of non-severe hypoglycaemic events among veterans with Type 2 diabetes and its association with primary care provider prescribing behaviour.
This was a prospective observational study involving 30 primary care providers and patients enrolled with these primary care providers, identified from computerized pharmacy records. Two sampling frames were created consisting of (1) patients not treated with insulin and receiving sulfonylurea treatment (with or without other oral hypoglycaemic agents) and (2) patients treated with insulin (with or without sulfonylureas or other oral hypoglycaemic agents). Patients recorded the frequency, proximal cause of, and response to each hypoglycaemic event over a 12-week period and made three visits to a research coordinator over 24 weeks. Data were provided to the primary care provider before their next visit and charts were reviewed for medication changes.
A total of 265 patients were enrolled in study. During the 12 weeks of structured self-monitoring of blood glucose, patients recorded a mean (sd) of 6.9 (10.3) hypoglycaemic events. Duration of diabetes increased monotonically with increasing category of hypoglycaemic event (P < 0.001). Among insulin users, an increased frequency of hypoglycaemic events was associated with a decreased likelihood of dose intensification by primary care providers (relative risk 0.86 per event; P = 0.02) but no significant increase in tendency for dose reduction (relative risk 1.04 per event; P = 0.06). Increased frequency of hypoglycaemic events was associated with an increased likelihood of dose reduction (relative risk 1.12 per event; P = 0.03) in the sulfonylurea treatment group.
Non-severe hypoglycaemia is common among veterans with Type 2 diabetes receiving insulin or sulfonylureas and influences the prescribing behaviour of primary care providers.
量化2型糖尿病退伍军人中非严重低血糖事件的发生率及其与初级保健提供者处方行为的关联。
这是一项前瞻性观察性研究，涉及30名初级保健提供者以及在这些初级保健提供者处登记的患者，这些患者从计算机化药房记录中识别出来。创建了两个抽样框架，分别为：（1）未接受胰岛素治疗且接受磺脲类治疗（无论是否使用其他口服降糖药）的患者；（2）接受胰岛素治疗的患者（无论是否使用磺脲类药物或其他口服降糖药）。患者记录了12周内每次低血糖事件的发生频率、近端原因及应对措施，并在24周内三次拜访研究协调员。在下一次就诊前将数据提供给初级保健提供者，并审查病历以了解用药变化情况。
共有265名患者纳入研究。在12周的结构化血糖自我监测期间，患者记录的低血糖事件平均（标准差）次数为6.9（10.3）次。糖尿病病程随低血糖事件类别增加而单调增加（P<0.001）。在胰岛素使用者中，低血糖事件发生频率增加与初级保健提供者增加剂量的可能性降低相关（每次事件相对风险为0.86；P=0.02），但减少剂量的趋势无显著增加（每次事件相对风险为1.04；P=0.06）。在磺脲类治疗组中，低血糖事件发生频率增加与减少剂量的可能性增加相关（每次事件相对风险为1.12；P=0.03）。
接受胰岛素或磺脲类治疗的2型糖尿病退伍军人中，非严重低血糖很常见，且会影响初级保健提供者的处方行为。
