Datta-Nemdharry Preeti, Thomson Andrew, Beynon Julie, Donegan Katherine
Vigilance and Risk Management of Medicines (VRMM), MHRA, London, UK.
Pharmacoepidemiol Drug Saf. 2017 Feb;26(2):127-135. doi: 10.1002/pds.4092. Epub 2016 Sep 19.
The purpose of this study is to characterise how Type 2 Diabetes Mellitus (T2DM) is treated in England and Wales and whether this adheres to 2009 National Institute for Health and Care Excellence (NICE) guidance on management of T2DM.
Data for T2DM patients aged 18+ years prescribed at least one anti-diabetic drug between 01/01/2000-30/06/2012 were extracted from the Clinical Practice Research Datalink. We examined the sequences in which anti-diabetic drugs were prescribed and, for patients on the most common anti-diabetic drug pathways, evaluated average HbA1c values at treatment initiation and at progression to a second or third-line anti-diabetic drug class, including insulin.
The cohort included 123 671 patients, 56% males, 95% aged 40+ and 79% with at least one recorded HbA1c level. Metformin was the first prescription for 98 957 (80%) patients, with mean HbA1c of 8.68% prior to initiation (95% confidence interval [CI] 8.67, 8.69). A total of 19 890 (16%) patients received sulphonylureas first-line (mean HbA1c = 9.31%, 95%CI 9.27, 9.35). 1402 (12%) insulin users were prescribed insulin first-line (mean HbA1c = 9.89%, 95%CI 9.59, 10.19). A total of 96 895 (78%) patients were managed in line with one of the treatment pathways recommended by NICE. Patients prescribed insulin second-line after metformin had a mean HbA1c of 10.11% (95%CI 9.83, 10.38) prior to first prescription of insulin and 9.98% (95%CI 9.73, 10.23) at baseline. Both values were significantly higher than other groups initiating new treatment.
In over three-quarters of patients, anti-diabetic drugs are being prescribed per NICE guidance. When insulin is being used earlier than recommended, there appears to be a need for urgent and rapid glycaemic control. © 2016 Crown Copyright. Pharmacoepidemiology and Drug Safety © 2016 John Wiley & Sons, Ltd.
本研究旨在描述英格兰和威尔士2型糖尿病（T2DM）的治疗方式，以及其是否遵循2009年英国国家卫生与临床优化研究所（NICE）关于T2DM管理的指南。
从临床实践研究数据链中提取2000年1月1日至2012年6月30日期间，年龄在18岁及以上且至少开具过一种抗糖尿病药物的T2DM患者的数据。我们检查了抗糖尿病药物的处方顺序，并针对使用最常见抗糖尿病药物治疗路径的患者，评估了开始治疗时以及进展至二线或三线抗糖尿病药物（包括胰岛素）时的平均糖化血红蛋白（HbA1c）值。
该队列包括123671名患者，其中56%为男性，95%年龄在40岁及以上，79%至少有一次记录的HbA1c水平。二甲双胍是98957名（80%）患者的首选用药，开始用药前的平均HbA1c为8.68%（95%置信区间[CI]8.67，8.69）。共有19890名（16%）患者一线使用磺脲类药物（平均HbA1c = 9.31%，95%CI 9.27，9.35）。1402名（12%）胰岛素使用者一线使用胰岛素（平均HbA1c = 9.89%，95%CI 9.59，10.19）。共有96895名（78%）患者按照NICE推荐的治疗路径之一进行管理。在二甲双胍之后二线使用胰岛素的患者，首次开具胰岛素前的平均HbA1c为10.11%（95%CI 9.83，10.38），基线时为9.98%（95%CI 9.73，10.23）。这两个值均显著高于开始新治疗的其他组。
超过四分之三的患者按照NICE指南开具抗糖尿病药物。当胰岛素的使用早于推荐时间时，似乎需要紧急且快速地控制血糖。© 2016英国皇家版权。药物流行病学与药物安全© 2016约翰·威利父子有限公司。
