Sterzi Daniel, Auziere Sébastien, Jensen Marie Markert, Lopes Sandra
a Kantar Health , Madrid , Spain.
b Kantar Health , Paris , France.
Curr Med Res Opin. 2017 Dec;33(12):2211-2216. doi: 10.1080/03007995.2017.1377165. Epub 2017 Oct 12.
Most diabetes care is done by GPs in Denmark. This study aimed to identify the barriers for GPs in initiating injectable therapies and reasons for referral to specialists. The web interview conducted included 85 GPs and 30 specialists experienced in type 2 diabetes (T2D). GPs felt more comfortable with initiating the first injectable therapy (defined as a glucagon-like peptide-1 receptor agonist (GLP-1 RA) or basal insulin) than the second (defined as adding a basal insulin in patients treated with a GLP-1 RA (± oral anti-diabetic treatments [OADs]), or adding either a GLP-1 RA or a bolus insulin in patients treated with basal insulin (± OADs). The main barriers to initiating injectables were related to the complexity of available injectable therapies and the lack of comfort with complex patient profiles, namely patients with difficult glycemia control or significant comorbidities, whom GPs would rather refer to specialists. Main attributes that would increase the GPs' comfort level with initiation of injectables are low risk of hypoglycemia, glycemic control improvement and ease of use of the treatment. An injectable therapy with such attributes could help to overcome barriers to initiating injectable in primary care.
在丹麦，大多数糖尿病护理工作由全科医生完成。本研究旨在确定全科医生在启动注射治疗时面临的障碍以及转诊至专科医生的原因。所进行的网络访谈涵盖了85名全科医生和30名在2型糖尿病（T2D）方面经验丰富的专科医生。与启动第二种注射治疗（定义为在接受胰高血糖素样肽-1受体激动剂（GLP-1 RA）治疗的患者中添加基础胰岛素（±口服抗糖尿病药物[OADs]），或在接受基础胰岛素治疗的患者中添加GLP-1 RA或餐时胰岛素（±OADs））相比，全科医生对启动第一种注射治疗（定义为GLP-1 RA或基础胰岛素）感觉更自在。启动注射治疗的主要障碍与现有注射治疗的复杂性以及对复杂患者情况（即血糖控制困难或有严重合并症的患者）缺乏信心有关，全科医生更愿意将这些患者转诊给专科医生。能够提高全科医生启动注射治疗舒适度的主要因素包括低血糖风险低、血糖控制改善以及治疗易用性。具有这些特性的注射治疗有助于克服初级保健中启动注射治疗的障碍。
