基层医疗与专科医疗中基础胰岛素起始治疗：两个不同患者群体的血糖控制情况相似。
Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations.
作者信息
Orozco-Beltran D, Pan C, Svendsen A L, Faerch L, Caputo S
机构信息
Department of Medicine, Cathedra of Family Medicine, University Miguel Hernandez, Alicante, Spain.
Department of Endocrinology, Chinese PLA General Hospital, Beijing, China.
出版信息
Int J Clin Pract. 2016 Mar;70(3):236-43. doi: 10.1111/ijcp.12776. Epub 2016 Feb 24.
OBJECTIVE
To investigate the effect of healthcare provider (HCP) type (primary vs. specialist) on glycaemic control and other treatment parameters.
RESEARCH DESIGN AND METHODS
Study of Once-Daily Levemir (SOLVE(™) ) is an international, 24-week, observational study of insulin initiation in people with type 2 diabetes.
RESULTS
A total of 17,374 subjects were included, comprising 4144 (23.9%) primary care subjects. Glycaemic control improved in both HCP groups from baseline to final visit [glycated haemoglobin (HbA1c) -1.2 ± 1.4% (-13.1 ± 15.3 mmol/mol) and -1.3 ± 1.6% (-14.2 ± 17.5 mmol/mol), respectively]. After adjustment for known confounders, there was no statistically significant effect of HCP group on final HbA1c [-0.04%, 95% confidence interval (CI) -0.09 to -0.01 (-0.4 mmol/mol, 95% CI -1.0-0.1 mmol/mol), p = 0.1590]. However, insulin doses at the final visit were higher in primary care patients (+0.06, 95% CI 0.06-0.07 U/kg, p < 0.0001). Logistic regression demonstrated a significant effect of HCP type (primary vs. specialist care) on hypoglycaemia risk [odds ratio (OR) 0.75, 95% CI 0.64-0.87, p = 0.0002]. Primary care physicians took more time to train patients and had more frequent contact with patients than specialists (both p < 0.0001).
CONCLUSIONS
Primary care physicians and specialists achieved comparable improvements in glycaemic control following insulin initiation.
目的
探讨医疗服务提供者（HCP）类型（初级保健医生与专科医生）对血糖控制及其他治疗参数的影响。
研究设计与方法
每日一次来得时（SOLVE(™)）研究是一项针对2型糖尿病患者起始胰岛素治疗的国际、为期24周的观察性研究。
结果
共纳入17374名受试者，其中4144名（23.9%）为初级保健受试者。从基线访视至末次访视，两组HCP的血糖控制均有所改善[糖化血红蛋白（HbA1c）分别降低1.2±1.4%（-13.1±15.3 mmol/mol）和1.3±1.6%（-14.2±17.5 mmol/mol）]。在对已知混杂因素进行校正后，HCP组对末次HbA1c无统计学显著影响[-0.04%，95%置信区间（CI）-0.09至-0.01（-0.4 mmol/mol，95% CI -1.0 - 0.1 mmol/mol），p = 0.1590]。然而，初级保健患者在末次访视时的胰岛素剂量更高（+0.06，95% CI 0.06 - 0.07 U/kg，p < 0.0001）。逻辑回归显示HCP类型（初级保健与专科护理）对低血糖风险有显著影响[比值比（OR）0.75，95% CI 0.64 - 0.87，p = 0.0002]。与专科医生相比，初级保健医生花费更多时间培训患者且与患者的接触更频繁（均p < 0.0001）。
结论
初级保健医生和专科医生在起始胰岛素治疗后血糖控制方面取得了相当的改善。
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