Yeh Alicia, Shah-Manek Bijal, Lor Kajua B
1 Touro University California College of Pharmacy, Vallejo, CA, USA.
2 OLE Health, Napa, CA, USA.
Ann Pharmacother. 2017 Feb;51(2):111-117. doi: 10.1177/1060028016673652. Epub 2016 Oct 17.
From 2009 to 2012, 51.8% of American adults with diabetes had a hemoglobin A (A1C) >7.0%. The complexity of antidiabetic medication regimens may have an impact on glycemic control.
The primary objective was to test the hypothesis that higher diabetes-specific medication regimen complexity index (MRCI) was associated with lower attainment of A1C goal <7.0% in an underserved, predominantly Hispanic population of adults with type 2 diabetes. Secondary analyses included less stringent A1C goals of <8.0% and <9.0% and overall patient-level MRCI.
This study was a retrospective, observational, cross-sectional study of individuals with type 2 diabetes from January 2011 to January 2016. Data was obtained from the electronic medical record and MRCI was calculated using the 65-item validated Microsoft Access Version 1.0 medication regimen complexity electronic data capture tool. Logistic regression was used to compute unadjusted and adjusted odds ratios.
A total of 368 patients were included in the analysis. High diabetes-specific MRCI was associated with lower attainment of A1C goal <7.0% (adjusted OR = 0.09; 95% CI = 0.04-0.18) controlling for age, gender, ethnicity, insurance, body mass index, smoking status, hypertension, and hyperlipidemia. Similar results were obtained for the less stringent A1C goals. However, results for overall patient-level MRCI were mixed.
Higher diabetes-specific medication regimen complexity was associated with poorer glycemic control. Simplifying antidiabetic medication regimens, especially where the treatment guidelines give no preference, could be a step toward achieving treatment goals.
2009年至2012年期间，51.8%的美国成年糖尿病患者糖化血红蛋白（A1C）>7.0%。抗糖尿病药物治疗方案的复杂性可能会对血糖控制产生影响。
主要目的是检验以下假设：在服务水平低下、以西班牙裔为主的2型糖尿病成年人群中，较高的糖尿病特异性药物治疗方案复杂性指数（MRCI）与A1C目标<7.0%的达标率较低相关。次要分析包括不太严格的A1C目标<8.0%和<9.0%以及总体患者水平的MRCI。
本研究是一项对2011年1月至2016年1月期间的2型糖尿病患者进行的回顾性、观察性横断面研究。数据从电子病历中获取，并使用经过验证的65项Microsoft Access 1.0版药物治疗方案复杂性电子数据捕获工具计算MRCI。采用逻辑回归计算未调整和调整后的比值比。
共有368名患者纳入分析。在控制年龄、性别、种族、保险、体重指数、吸烟状况、高血压和高脂血症后，高糖尿病特异性MRCI与A1C目标<7.0%的达标率较低相关（调整后的OR = 0.09；95% CI = 0.04 - 0.18）。对于不太严格的A1C目标也获得了类似结果。然而，总体患者水平MRCI的结果参差不齐。
较高的糖尿病特异性药物治疗方案复杂性与较差的血糖控制相关。简化抗糖尿病药物治疗方案，尤其是在治疗指南没有偏好的情况下，可能是朝着实现治疗目标迈出的一步。
