Schaper Nicolaas C, Nikolajsen Annie, Sandberg Anna, Buchs Sarah, Bøgelund Mette
Department of Internal Medicine, CAPHRI School for Public Health and Primary Care and CARIM Institute, Maastricht, The Netherlands.
Novo Nordisk A/S, Copenhagen, Denmark.
Diabetes Ther. 2017 Dec;8(6):1319-1329. doi: 10.1007/s13300-017-0317-9. Epub 2017 Oct 23.
We investigated the association of bolus insulin dose timing with demographics, adherence, diabetes education program participation, experience with hypoglycemic events, glycemic control, and patient preference among respondents with type 2 diabetes.
Adults with type 2 diabetes from 12 countries were recruited to a Web-based self-reported patient preference survey. Adherence was measured using an adapted Morisky Medication Adherence Scale questionnaire.
In total 1483 respondents reported using bolus insulin with 58% (n = 864) dosing bolus insulin before meals (pre-meal cohort), 354 (24%) during or after meals (post-meal cohort), and 265 (18%) before, during, or after meals (mixed cohort). The mixed cohort was excluded, thus 1218 respondents were included in the analysis. Respondent distribution across HbA category differed significantly depending on insulin dose timing (p = 0.0006); more respondents in the post-meal cohort (40%) had HbA ≥ 9% (74.9 mmol/mol) than in the pre-meal cohort (29%). The post-meal cohort was significantly more likely to report non-adherence than the pre-meal cohort (OR = 1.50, p = 0.01) and significantly more often reported participating in diabetes education programs (p < 0.05). Seventy-eight percent of all respondents reported preferring bolus insulin administrable whenever convenient.
Approximately 24% of respondents never comply with guidelines for insulin dose timing, with higher risk of non-adherence and increased participation in diabetes care programs. Respondents dosing insulin post-meal are more likely to have poor glycemic control (HbA ≥ 9%, 74.9 mmol/mol). Given that many respondents had high HbA and were non-adherent, a treatment which satisfies patient preference for bolus insulin with flexible dose timing could be considered.
Novo Nordisk.
我们调查了2型糖尿病患者中推注胰岛素剂量时间与人口统计学、依从性、糖尿病教育项目参与情况、低血糖事件经历、血糖控制及患者偏好之间的关联。
招募来自12个国家的成年2型糖尿病患者参与一项基于网络的自我报告患者偏好调查。使用改编后的Morisky药物依从性量表问卷来衡量依从性。
共有1483名受访者报告使用推注胰岛素，其中58%（n = 864）在饭前注射推注胰岛素（饭前组），354名（24%）在饭后或用餐期间注射（饭后组），265名（18%）在饭前、用餐期间或饭后注射（混合组）。混合组被排除，因此1218名受访者纳入分析。根据胰岛素剂量时间不同，HbA类别中的受访者分布存在显著差异（p = 0.0006）；饭后组中HbA≥9%（74.9 mmol/mol）的受访者（40%）比饭前组（29%）更多。饭后组报告不依从的可能性显著高于饭前组（OR = 1.50，p = 0.01），且参与糖尿病教育项目的报告频率也显著更高（p < 0.05）。78%的受访者表示更喜欢在方便时注射推注胰岛素。
约24%的受访者从未遵循胰岛素剂量时间指南，不依从风险更高，参与糖尿病护理项目的比例增加。饭后注射胰岛素的受访者血糖控制不佳（HbA≥9%，74.9 mmol/mol）的可能性更大。鉴于许多受访者HbA水平较高且不依从，可以考虑一种能满足患者对灵活剂量时间推注胰岛素偏好的治疗方法。
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