Kaplan R M, Ganiats T G
Department of Community and Family Medicine, University of California, San Diego, La Jolla 92093.
J Gen Intern Med. 1989 Mar-Apr;4(2):167-71. doi: 10.1007/BF02602360.
In order to evaluate the choice among alternatives quantitatively, a formal decision model must be developed. Yet the literature does not currently include the information required to develop this model. Data tell us very little about what factors should be considered in the choice of treatment for NIDDM patients. Table 1 summarizes some of the advantages and disadvantages of insulin, sulfonylureas, and dietary treatments. Insulin may have the greatest effect upon blood glucose, but may also be associated with the greatest likelihood of nuisance for the patient. At the other extreme, dietary treatment may be safe, but may have a low probability of achieving long-term blood glucose control. There is remarkably little in the literature that considers nuisance factors for the patient, minor but persistent side effects, or the likelihood of other physical changes such as weight gain. We know even less about how to integrate preferences for benefits and side effects into a comprehensive decision. Although some profiles of laboratory results clearly dictate a treatment protocol, there is considerable variability in the treatment options for a large number of NIDDM patients. Consider, for example, the patient who has a fasting blood glucose of 250 mg/dl but no symptoms. There may be several treatment alternatives. Yet the chances of therapeutic success could be influenced by the patient's concern about being dependent upon medication, willingness to comply with life-style changes, and fear of using needles. We suggest that the patient must be active in negotiating the choice of treatment, and that patient preferences for expected outcomes, side effects, and nuisance factors need to be considered.(ABSTRACT TRUNCATED AT 250 WORDS)
为了定量评估备选方案之间的选择，必须建立一个正式的决策模型。然而，目前的文献中并不包含建立该模型所需的信息。数据几乎没有告诉我们在选择2型糖尿病患者的治疗方法时应考虑哪些因素。表1总结了胰岛素、磺脲类药物和饮食治疗的一些优缺点。胰岛素可能对血糖有最大的影响，但也可能给患者带来最大的不便。另一方面，饮食治疗可能是安全的，但实现长期血糖控制的可能性较低。文献中很少考虑患者的不便因素、轻微但持续的副作用或其他身体变化的可能性，如体重增加。我们对如何将对益处和副作用的偏好整合到一个全面的决策中了解得更少。尽管一些实验室检查结果明确规定了治疗方案，但大量2型糖尿病患者的治疗选择存在很大差异。例如，考虑一位空腹血糖为250毫克/分升但没有症状的患者。可能有几种治疗选择。然而，治疗成功的机会可能会受到患者对依赖药物的担忧、对生活方式改变的依从性以及对使用针头的恐惧的影响。我们建议患者必须积极参与治疗选择的协商，并且需要考虑患者对预期结果、副作用和不便因素的偏好。（摘要截短至250字）
