全球 2018-2030 年用于 2 型糖尿病的胰岛素使用估计：微观模拟分析。

Estimation of global insulin use for type 2 diabetes, 2018-30: a microsimulation analysis.

机构信息

Center for Primary Care and Outcomes Research and Center for Population Health Sciences, Departments of Medicine and of Health Research and Policy, Stanford University, Palo Alto, CA, USA; Center for Primary Care, Harvard Medical School, Boston, MA, USA.

Institute of Cardiovascular Science, Division of Medicine, University College London, London, UK.

出版信息

Lancet Diabetes Endocrinol. 2019 Jan;7(1):25-33. doi: 10.1016/S2213-8587(18)30303-6. Epub 2018 Nov 21.

DOI:10.1016/S2213-8587(18)30303-6

PMID:30470520

Abstract

BACKGROUND

The amount of insulin needed to effectively treat type 2 diabetes worldwide is unknown. It also remains unclear how alternative treatment algorithms would affect insulin use and disability-adjusted life-years (DALYs) averted by insulin use, given that current access to insulin (availability and affordability) in many areas is low. The aim of this study was to compare alternative projections for and consequences of insulin use worldwide under varying treatment algorithms and degrees of insulin access.

METHODS

We developed a microsimulation of type 2 diabetes burden from 2018 to 2030 across 221 countries using data from the International Diabetes Federation for prevalence projections and from 14 cohort studies representing more than 60% of the global type 2 diabetes population for HbA, treatment, and bodyweight data. We estimated the number of people with type 2 diabetes expected to use insulin, international units (IU) required, and DALYs averted per year under alternative treatment algorithms targeting HbA from 6·5% to 8%, lower microvascular risk, or higher HbA for those aged 75 years and older.

FINDINGS

The number of people with type 2 diabetes worldwide was estimated to increase from 405·6 million (95% CI 315·3 million-533·7 million) in 2018 to 510·8 million (395·9 million-674·3 million) in 2030. On this basis, insulin use is estimated to increase from 516·1 million 1000 IU vials (95% CI 409·0 million-658·6 million) per year in 2018 to 633·7 million (500·5 million-806·7 million) per year in 2030. Without improved insulin access, 7·4% (95% CI 5·8-9·4) of people with type 2 diabetes in 2030 would use insulin, increasing to 15·5% (12·0-20·3) if insulin were widely accessible and prescribed to achieve an HbA of 7% (53 mmol/mol) or lower. If HbA of 7% or lower was universally achieved, insulin would avert 331 101 DALYs per year by 2030 (95% CI 256 601-437 053). DALYs averted would increase by 14·9% with access to newer oral antihyperglycaemic drugs. DALYs averted would increase by 44·2% if an HbA of 8% (64 mmol/mol) were used as a target among people aged 75 years and older because of reduced hypoglycaemia.

INTERPRETATION

The insulin required to treat type 2 diabetes is expected to increase by more than 20% from 2018 to 2030. More DALYs might be averted if HbA targets are higher for older adults.

FUNDING

The Leona M and Harry B Helmsley Charitable Trust.

摘要

背景

目前尚不清楚全球范围内治疗 2 型糖尿病所需的胰岛素剂量。此外，鉴于目前许多地区胰岛素的可及性（供应和可负担性）较低，替代治疗方案将如何影响胰岛素的使用以及胰岛素使用所避免的伤残调整生命年（DALYs），这一点也不清楚。本研究旨在比较不同治疗方案和不同胰岛素可及性程度下，全球胰岛素使用的替代预测结果和后果。

方法

我们使用国际糖尿病联合会（International Diabetes Federation）的患病率预测数据以及来自 14 项队列研究的数据，这些研究代表了全球超过 60%的 2 型糖尿病患者的 HbA、治疗和体重数据，从 2018 年到 2030 年，在 221 个国家/地区对 2 型糖尿病负担进行了基于微模拟的研究。我们根据不同的治疗方案，针对 HbA 为 6.5%至 8%、微血管风险更低或年龄在 75 岁及以上人群 HbA 更高的目标，估计了每年使用胰岛素的 2 型糖尿病患者人数、所需的国际单位（IU）数量以及避免的 DALYs。

结果

预计全球 2 型糖尿病患者人数将从 2018 年的 4.056 亿（95%CI，3.153 亿-5.337 亿）增加到 2030 年的 5.108 亿（3.959 亿-6.743 亿）。在此基础上，胰岛素的使用量预计将从 2018 年的 5.161 亿支（1000 IU 药瓶）（95%CI，4.090 亿-6.586 亿）增加到 2030 年的 6.337 亿支（5.005 亿-8.067 亿）。如果胰岛素的可及性没有改善，到 2030 年，将有 7.4%（95%CI，5.8-9.4）的 2 型糖尿病患者使用胰岛素，如果胰岛素广泛可用并规定用于将 HbA 控制在 7%（53 mmol/mol）或更低水平，这一比例将上升到 15.5%（12.0-20.3）。如果普遍实现 HbA 为 7%或更低，到 2030 年，胰岛素每年可避免 331010 DALYs（95%CI，256601-437053）。如果为 75 岁及以上的人群设定 HbA 为 8%（64 mmol/mol）作为目标，胰岛素的使用量将增加 14.9%，因为这会减少低血糖的发生。如果将 HbA 目标设定为 8%（64 mmol/mol），则可以避免更多的 DALYs，因为 75 岁及以上的人群发生低血糖的风险降低。