Kostev K, Dippel F W, Rathmann W
IMS HEALTH, Frankfurt, Germany.
Sanofi-Aventis Deutschland GmbH, Berlin, Germany.
Prim Care Diabetes. 2016 Apr;10(2):142-7. doi: 10.1016/j.pcd.2015.08.001. Epub 2015 Aug 29.
To identify patient-related characteristics and other impact factors predicting early discontinuation of basal insulin therapy in type 2 diabetes in primary care.
A total of 4837 patients who started basal insulin therapy (glargine: n=3175; NPH: n=1662) in 1072 general and internal medicine practices throughout Germany were retrospectively analyzed (Disease Analyser Database: 01/2008-03/2014). Early discontinuation was defined as switching back to oral antidiabetic drugs (OAD) therapy within 90 days after first basal insulin prescription (index date, ID). Patient records were assessed 365 days prior and post ID. Logistic regression models were used to adjust for age, sex, diabetes duration, diabetologist care, disease management program participation, HbA1c, and comorbidity.
Within 3 months after ID, 202 (6.8%) of glargine patients switched back to OAD (NPH: 130 (8.5%); p<0.05). In multivariable logistic regression, predictors of early basal insulin discontinuation were ≥1 documented hypoglycemia before ID (adjusted Odds ratio; 95% CI: 2.20; 1.27-3.82), diagnosed depression (1.31; 1.01-1.70) and referrals to specialists within 90 days after ID (2.06; 1.61-2.63). Diabetologist care (0.57; 0.36-0.89) and glargine treatment (vs. NPH: 0.78; 0.61-0.98) were related to a lower odds of having early insulin discontinuation.
Less than 10% of type 2 diabetes patients switched back to oral antidiabetic drugs within 90 days after start of basal insulin therapy. In particular, patients with baseline depression and frequent or severe hypoglycemia have a higher likelihood for early discontinuation of basal insulin, whereas use of insulin glargine and diabetologist care are related to an increased chance of continuous insulin treatment.
确定在初级保健中预测2型糖尿病患者基础胰岛素治疗早期停药的患者相关特征及其他影响因素。
对德国1072家普通内科和内科诊所中开始基础胰岛素治疗（甘精胰岛素：n = 3175；中性鱼精蛋白锌胰岛素：n = 1662）的4837例患者进行回顾性分析（疾病分析数据库：2008年1月 - 2014年3月）。早期停药定义为在首次开具基础胰岛素处方（索引日期，ID）后90天内转回口服抗糖尿病药物（OAD）治疗。在ID前后365天评估患者记录。使用逻辑回归模型对年龄、性别、糖尿病病程、糖尿病专家护理、疾病管理项目参与情况、糖化血红蛋白和合并症进行校正。
在ID后3个月内，202例（6.8%）甘精胰岛素患者转回OAD治疗（中性鱼精蛋白锌胰岛素：130例（8.5%）；p<0.05）。在多变量逻辑回归中，基础胰岛素早期停药的预测因素为ID前记录有≥1次低血糖（校正比值比；95%置信区间：2.20；1.27 - 3.82）、诊断为抑郁症（1.31；1.01 - 1.70）以及ID后90天内转诊至专科医生（2.06；1.61 - 2.63）。糖尿病专家护理（0.57；0.36 - 0.89）和甘精胰岛素治疗（与中性鱼精蛋白锌胰岛素相比：0.78；0.61 - 0.98）与早期胰岛素停药几率较低相关。
不到10%的2型糖尿病患者在开始基础胰岛素治疗后90天内转回口服抗糖尿病药物治疗。特别是，基线有抑郁症以及频繁或严重低血糖的患者早期停用基础胰岛素的可能性更高，而使用甘精胰岛素和糖尿病专家护理与持续胰岛素治疗的机会增加相关。
