Metcalfe Scott, Moodie Peter, Norris Hew, Rasiah Dilky
PHARMAC, PO Box 10-254, Wellington, New Zealand.
N Z Med J. 2014 Nov 28;127(1406):48-62.
(1) To identify actual dispensings of publicly funded blood glucose test strips (SMBG) in New Zealand according to severity of disease, as proxied by the type of medicines prescribed; and (2) To compare these rates with published consensus guidelines on SMBG usage.
All dispensings of diabetes medicines and blood glucose test strips (SMBG) in 2011 were identified and matched to patients, using encrypted National Health Index numbers (NHIs). Five hierarchical treatment groups were identified, as the use of: -Insulins without oral hypoglycaemic agents (OHs); -Insulins with OHs; -Sulphonylurea-containing OH regimens without insulins (with or without other diabetes medicines); -Metformin alone, with or without glitazones or acarbose; and -No diabetes medication but accessing SMBGs. The average SMBG dispensings to patients in each of these groups was then calculated. The calculation was performed only for 'steady-state' patients, i.e. patients assumed stabilised on the same medication regimen for at least one year. Differences between actual and expected dispensings were calculated from expected daily strip use for each group.
An estimated 183,000 patients were dispensed diabetes medicines and/or SMBG during 2011. Of these, 122,000 were identified as 'steady-state' patients. Patient numbers and median ages varied widely across treatment groups and by gender and ethnicity. Dispensing rates for SMBG varied by treatment group, with probable over-dispensing in some groups and under-dispensing in others when compared with published guidelines. In particular there appeared to be relatively large under-dispensing of SMBG in patients requiring insulin (especially the 25-44 age-group or Maori and Pacific peoples) and a high over-dispensing in those using metformin alone or on no diabetic medication.
There are appreciable variations in the use of SMBG between treatment groups. Adherence to published guidelines may improve efficacy and health outcomes for those using insulin and reduce pain, anxiety and disruption for those using metformin or diet alone for control of their diabetes.
（1）根据所开药物类型这一疾病严重程度的指标，确定新西兰公费血糖试纸（自我血糖监测）的实际配给情况；（2）将这些配给率与已发表的自我血糖监测使用共识指南进行比较。
利用加密的国民健康指数编号（NHIs），识别出2011年所有糖尿病药物和血糖试纸（自我血糖监测）的配给情况，并将其与患者进行匹配。确定了五个分级治疗组，分别为：- 使用胰岛素但未使用口服降糖药（OHs）；- 使用胰岛素和OHs；- 含磺脲类的OH治疗方案但未使用胰岛素（有或无其他糖尿病药物）；- 单独使用二甲双胍，有或无格列酮类或阿卡波糖；- 未使用糖尿病药物但可获得自我血糖监测试纸。然后计算每组患者的平均自我血糖监测试纸配给量。该计算仅针对“稳态”患者，即假定在相同药物治疗方案下稳定至少一年的患者。根据每组预期的每日试纸使用量计算实际配给量与预期配给量之间的差异。
2011年估计有18.3万名患者获得了糖尿病药物和/或自我血糖监测试纸。其中，12.2万名被确定为“稳态”患者。各治疗组的患者数量和年龄中位数因性别和种族而异。自我血糖监测试纸的配给率因治疗组而异，与已发表的指南相比，某些组可能存在配给过量，而其他组则存在配给不足。特别是，需要胰岛素治疗的患者（尤其是25 - 44岁年龄组或毛利人和太平洋岛民）的自我血糖监测试纸配给量似乎相对较低，而单独使用二甲双胍或未使用糖尿病药物的患者则存在较高的配给过量情况。
各治疗组在自我血糖监测试纸的使用上存在明显差异。遵循已发表的指南可能会提高使用胰岛素患者的疗效和健康结局，并减少单独使用二甲双胍或饮食控制糖尿病患者的痛苦、焦虑和干扰。
