Linetzky Bruno, Curtis Brad, Frechtel Gustavo, Montenegro Renan, Escalante Pulido Miguel, Stempa Oded, de Lana Janaina Martins, Gagliardino Juan José
Eli Lilly and Company, Tronador 4890, Piso 12, CABA, C1430DNN Buenos Aires, Argentina.
Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285 USA.
Diabetol Metab Syndr. 2016 Jul 22;8:41. doi: 10.1186/s13098-016-0157-1. eCollection 2016.
Poor glycemic control in patients with type 2 diabetes is commonly recorded worldwide; Latin America (LA) is not an exception. Barriers to intensifying insulin therapy and which barriers are most likely to negatively impact outcomes are not completely known. The objective was to identify barriers to insulin progression in individuals with type 2 diabetes mellitus (T2DM) in LA countries (Mexico, Brazil, and Argentina).
MOSAIc is a multinational, non-interventional, prospective, observational study aiming to identify the patient-, physician-, and healthcare-based factors affecting insulin intensification. Eligible patients were ≥18 years, had T2DM, and were treated with insulin for ≥3 months with/without oral antidiabetic drugs (OADs). Demographic, clinical, and psychosocial data were collected at baseline and regular intervals during the 24-month follow-up period. This paper however, focuses on baseline data analysis. The association between glycated hemoglobin (HbA1c) and selected covariates was assessed.
A trend toward a higher level of HbA1c was observed in the LA versus non-LA population (8.40 ± 2.79 versus 8.18 ± 2.28; p ≤ 0.069). Significant differences were observed in clinical parameters, treatment patterns, and patient-reported outcomes in LA compared with the rest of the cohorts and between Mexico, Brazil, and Argentina. Higher number of insulin injections and lower number of OADs were used, whereas a lower level of knowledge and a higher level of diabetes-related distress were reported in LA. Covariates associated with HbA1c levels included age (-0.0129; p < 0.0001), number of OADs (0.0835; p = 0.0264), higher education level (-0.2261; p = 0.0101), healthy diet (-0.0555; p = 0.0083), self-monitoring blood glucose (-0.0512; p = 0.0033), hurried communication style in the process of care (0.1295; p = 0.0208), number of insulin injections (0.1616; p = 0.0088), adherence (-0.1939; p ≤ 0.0104), and not filling insulin prescription due to associated cost (0.2651; p = 0.0198).
MOSAIc baseline data showed that insulin intensification in LA is not optimal and identified several conditions that significantly affect attaining appropriate HbA1c values. Tailored public health strategies, including education, should be developed to overcome such barriers. Trial Registration NCT01400971.
2型糖尿病患者血糖控制不佳在全球范围内普遍存在；拉丁美洲（LA）也不例外。强化胰岛素治疗的障碍以及哪些障碍最有可能对治疗结果产生负面影响尚不完全清楚。目的是确定拉丁美洲国家（墨西哥、巴西和阿根廷）2型糖尿病（T2DM）患者胰岛素治疗进展的障碍。
MOSAIc是一项多国、非干预性、前瞻性观察性研究，旨在确定影响胰岛素强化治疗的患者、医生和医疗保健相关因素。符合条件的患者年龄≥18岁，患有T2DM，接受胰岛素治疗≥3个月，无论是否使用口服降糖药（OADs）。在24个月的随访期内，在基线和定期收集人口统计学、临床和社会心理数据。然而，本文重点关注基线数据分析。评估糖化血红蛋白（HbA1c）与选定协变量之间的关联。
与非拉丁美洲人群相比，拉丁美洲人群中观察到HbA1c水平有升高趋势（8.40±2.79对8.18±2.28；p≤0.069）。与其他队列相比，以及在墨西哥、巴西和阿根廷之间，拉丁美洲在临床参数、治疗模式和患者报告的结果方面存在显著差异。胰岛素注射次数较多，OADs使用次数较少，而拉丁美洲报告的知识水平较低，糖尿病相关困扰水平较高。与HbA1c水平相关的协变量包括年龄（-0.0129；p<0.0001）、OADs数量（0.0835；p=0.0264）、高等教育水平（-0.2261；p=0.0101）、健康饮食（-0.0555；p=0.0083）、自我血糖监测（-0.0512；p=0.0033）、护理过程中的匆忙沟通方式（0.1295；p=0.0208）、胰岛素注射次数（0.1616；p=0.0088）、依从性（-0.1939；p≤0.0104）以及因相关费用未开具胰岛素处方（0.2651；p=0.0198）。
MOSAIc基线数据显示，拉丁美洲的胰岛素强化治疗并非最佳，并确定了几个显著影响达到适当HbA1c值的因素。应制定包括教育在内的针对性公共卫生策略来克服这些障碍。试验注册号NCT01400971。
