Koren Shlomit, Yoshpa Michael, Koren Ronit, Cantrell Dror, Rapoport Micha J
Diabetes Unit, Assaf Harofeh Medical Center, Zerifin, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr Med Assoc J. 2018 Nov;20(11):691-694.
Basal-bolus (BB) insulin treatment is increasingly used in poorly controlled diabetes patients during hospitalization and is commonly recommended at discharge; however, the extent of adherence with this recommendation is unknown.
To determine short-term adherence of type 2 diabetes mellitus (T2DM) patients discharged from internal medicine wards with recommendation for BB insulin treatment.
Prescription (primary physician adherence) and purchase (patient adherence) of long-acting and short-acting insulins during the first month following discharge from internal medicine wards was determined in 153 T2DM patients. Adherence was defined as full if prescription/purchase of both basal (long-acting) and bolus (short-acting) insulin was completed, and as partial if only one kind of insulin (basal or bolus) was prescribed/purchased. Association between demographic and clinical parameters and adherence was determined.
Full adherence with discharge instructions was higher for primary physicians than for patients )79.1% vs. 69.3%, respectively, P = 0.0182). Pre-hospitalization hemoglobin A1C was significantly associated with adherence by both patients and primary physicians (full-adherence group 9.04% ± 2.04%; no-adherence group 7.51% ± 1.35%, P = 0.002). Age was negatively associated with adherence of both primary physicians and patients; however, this association did not reach statistical significance. Patients with certain background diseases such as atrial fibrillation, coronary heart disease, and chronic heart failure had significantly worse adherence (P < 0.05). When the sole cause of admission was diabetes, full adherence (100%) of both primary physicians and patients was found.
Short-term adherence with discharge recommendation for BB insulin treatment is associated with pre-hospitalization patient characteristics.
基础-餐时（BB）胰岛素治疗在住院期间血糖控制不佳的糖尿病患者中使用越来越多，且通常在出院时被推荐使用；然而，遵循这一推荐的程度尚不清楚。
确定内科病房出院的2型糖尿病（T2DM）患者对BB胰岛素治疗推荐的短期依从性。
对153例T2DM患者出院后第一个月长效和短效胰岛素的处方（主治医师依从性）和购买情况（患者依从性）进行了测定。如果基础（长效）和餐时（短效）胰岛素的处方/购买均完成，则依从性定义为完全依从；如果仅处方/购买了一种胰岛素（基础或餐时），则依从性定义为部分依从。确定人口统计学和临床参数与依从性之间的关联。
主治医师对出院医嘱的完全依从性高于患者（分别为79.1%和69.3%，P = 0.0182）。住院前糖化血红蛋白与患者和主治医师的依从性均显著相关（完全依从组9.04%±2.04%；不依从组7.51%±1.35%，P = 0.002）。年龄与主治医师和患者的依从性均呈负相关；然而，这种关联未达到统计学意义。患有某些背景疾病如心房颤动、冠心病和慢性心力衰竭的患者依从性明显较差（P < 0.05）。当入院的唯一原因是糖尿病时，发现主治医师和患者的完全依从性均为100%。
BB胰岛素治疗出院推荐的短期依从性与住院前患者特征有关。
