Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 6500017, Japan.
Division of Endocrinology and Metabolism, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
Endocrine. 2019 May;64(2):233-238. doi: 10.1007/s12020-018-1793-z. Epub 2018 Oct 26.
Hypoglycemia is a common and life-threatening complication in type 1 diabetes mellitus (T1DM) patients. Current guidelines recommend glucagon for treating hypoglycemia in out-of-hospital settings; however, glucagon is reportedly underused in such patients. We conducted a doctor-oriented, questionnaire-based survey of pediatricians and physicians to determine the glucagon prescription rate and identify the reason(s) for its underuse in T1DM patients.
A questionnaire was mailed to 415 pediatricians and 200 physicians employed at 66 facilities with >100 general wards throughout Hyogo, Japan. The following variables were surveyed: doctor's specialty, glucagon prescription rate, familiarity with glucagon use guidelines, barriers to prescribing glucagon, and attitude changes after education.
After 16 doctors were found to have retired, 599 doctors were enrolled; 305 (187 pediatricians and 118 physicians) returned a completed questionnaire. In all, 45 pediatricians and 104 physicians were treating T1DM patients, of whom 24% and 28% reported prescribing glucagon, respectively. The guideline familiarity rate among pediatricians was lower than that among physicians. The major barrier to prescribing glucagon was the complex preparation procedure required by patients/caregivers. More than half of the doctors who did not prescribe glucagon began doing so after being educated about the guidelines.
The glucagon prescription rate was low among both pediatricians and physicians in Japan.
低血糖是 1 型糖尿病（T1DM）患者常见且危及生命的并发症。目前的指南建议在院外环境中使用胰高血糖素治疗低血糖；然而，据报道，此类患者中胰高血糖素的使用不足。我们进行了一项以医生为导向的、基于问卷调查的儿科医生和内科医生调查，以确定胰高血糖素的处方率，并确定 T1DM 患者中使用不足的原因。
向日本兵库县的 66 家拥有 100 多个普通病房的设施中的 415 名儿科医生和 200 名医生邮寄了一份问卷。调查了以下变量：医生的专业、胰高血糖素的处方率、对胰高血糖素使用指南的熟悉程度、开具胰高血糖素处方的障碍，以及教育后的态度变化。
在发现 16 名医生退休后，共有 599 名医生参与了调查；其中 305 名（187 名儿科医生和 118 名内科医生）返回了完整的问卷。共有 45 名儿科医生和 104 名内科医生在治疗 T1DM 患者，其中分别有 24%和 28%的人报告开具了胰高血糖素。儿科医生对指南的熟悉程度低于内科医生。开具胰高血糖素的主要障碍是患者/护理人员所需的复杂准备程序。在接受了关于指南的教育后，超过一半的没有开具胰高血糖素的医生开始这样做。
日本的儿科医生和内科医生开具胰高血糖素的处方率都很低。
