口服抗糖尿病药物的依从性和 2 型糖尿病患者的血糖控制：在沙特阿拉伯一家三级医院进行的横断面回顾性研究。
Oral antidiabetic medication adherence and glycaemic control among patients with type 2 diabetes mellitus: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia.
机构信息
Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
Drug Sector, Saudi Food and Drug Authority, Riyadh, Riyadh, Saudi Arabia.
出版信息
BMJ Open. 2019 Jul 23;9(7):e029280. doi: 10.1136/bmjopen-2019-029280.
OBJECTIVES
The purpose of this study is to measure the adherence rates of oral antidiabetic drugs (OADs) in patients with type 2 diabetes mellitus (T2DM) and assess the relationship of glycaemic control and adherence to OADs after controlling for other associated factors.
DESIGN
Cross-sectional retrospective study.
SETTING
Large tertiary hospital in the central region of Saudi Arabia.
PARTICIPANTS
5457patients aged 18 years and older diagnosed with T2DM during the period from 1 January 2016 to 31 December 2016.
PRIMARY AND SECONDARY OUTCOME MEASURES
The modified medication possession ratio (mMPR) was calculated as a proxy measure for adherence of OADs. The factors associated with OADs non-adherence and medication oversupply were assessed using multinomial logistic regression models. The secondary outcomes were to measure the association between OADs adherence and glycaemic control.
RESULTS
Majority of patients with T2DM were females (n=3400, 62.3%). The average glycated haemoglobin was 8.2±1.67. Among the study population, 48.6% had good adherence (mMPR >0.8) and 8.6% had a medication oversupply (mMPR >1.2). Good adherence was highest among those using repaglinide (71.0%) followed by pioglitazone (65.0%) and sitagliptin (59.0%). In the multivariate analysis, women with T2DM were more likely to have poor adherence (adjusted OR (AOR)=0.76, 95% CI=0.67, 0.86) compared with men. Also, medication oversupply was more likely among patients with hyperpolypharmacy (AOR=1.88, 95% CI=1.36, 2.63), comorbid osteoarthritis (AOR=1.72, 95% CI=1.20, 02.45) and non-Saudi patients (AOR=1.53, 95% CI=1.16, 2.01). However, no association was found between glycaemic control and adherence to OADs.
CONCLUSION
The study findings support the growing concern of non-adherence to OADs among patients with T2DM in Saudi Arabia. Decision makers have to invest in behavioural interventions that will boost medication adherence rates. This is particularly important in patients with polypharmacy and high burden of comorbid conditions.
目的
本研究旨在测量 2 型糖尿病（T2DM）患者口服降糖药（OAD）的依从率，并在控制其他相关因素后评估血糖控制与 OAD 依从性的关系。
设计
横断面回顾性研究。
地点
沙特阿拉伯中部地区的一家大型三级医院。
参与者
2016 年 1 月 1 日至 2016 年 12 月 31 日期间诊断为 T2DM 的 5457 名年龄在 18 岁及以上的患者。
主要和次要结果
使用改良药物持有率（mMPR）作为 OAD 依从性的替代指标进行计算。使用多项逻辑回归模型评估与 OAD 不依从和药物过量相关的因素。次要结果是测量 OAD 依从性与血糖控制之间的关系。
结果
大多数 T2DM 患者为女性（n=3400，62.3%）。平均糖化血红蛋白为 8.2±1.67。在研究人群中，48.6%的患者具有良好的依从性（mMPR>0.8），8.6%的患者存在药物过量（mMPR>1.2）。使用瑞格列奈（71.0%）、吡格列酮（65.0%）和西他列汀（59.0%）的患者依从性最高。在多变量分析中，与男性相比，女性 T2DM 患者更有可能依从性差（调整后的 OR（AOR）=0.76，95%CI=0.67，0.86）。此外，高药物负荷（AOR=1.88，95%CI=1.36，2.63）、合并骨关节炎（AOR=1.72，95%CI=1.20，02.45）和非沙特患者（AOR=1.53，95%CI=1.16，2.01）更有可能发生药物过量。然而，血糖控制与 OAD 依从性之间没有关联。
结论
研究结果支持沙特阿拉伯 T2DM 患者对 OAD 依从性日益关注的问题。决策者必须投资于促进药物依从性的行为干预措施。这在药物负荷高且合并症负担重的患者中尤为重要。
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