Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
Brigham and Women's Hospital, Boston, MA, United States of America.
J Diabetes Complications. 2019 Nov;33(11):107418. doi: 10.1016/j.jdiacomp.2019.107418. Epub 2019 Aug 19.
Decline of insulin therapy by patients is common but poorly investigated. We conducted this study to determine patient and treatment characteristics predictive of glycemic control after declining clinician recommendation to initiate insulin therapy.
We retrospectively studied adults with type 2 diabetes mellitus treated at two academic medical centers between 1993 and 2014 who declined their healthcare provider recommendation to initiate insulin.
In a multivariable analysis of 300 study patients adjusted for demographics, comorbidities and clustering within providers, higher baseline HbA1c (OR 1.85; 95% CI 1.40 to 2.39; p < 0.001) and lifestyle changes (OR 8.39; 95% CI 3.26 to 21.55; p < 0.001) were associated with greater, while non-adherence to diabetes medications (OR 0.014; 95% CI 0.0025 to 0.085; p < 0.001) and discontinuation of a non-insulin diabetes medication (OR 0.30; 95% CI 0.11 to 0.80; p = 0.016) were associated with lower probability of HbA1c decrease after declining insulin therapy.
We identified patient characteristics and treatment strategies associated with success and failure of glycemic control after insulin therapy decline by the patient. This information can assist in selection of optimal therapeutic approaches for these individuals.
患者停用胰岛素治疗较为常见，但研究甚少。本研究旨在确定预测临床医生建议起始胰岛素治疗后血糖控制不佳的患者和治疗特征。
我们回顾性研究了 1993 年至 2014 年在两个学术医疗中心接受治疗的 2 型糖尿病患者，这些患者拒绝了其医疗服务提供者建议起始胰岛素治疗。
在对 300 例研究患者进行多变量分析，调整了人口统计学、合并症和提供者内聚类后，基线 HbA1c 较高（OR 1.85；95%CI 1.40 至 2.39；p<0.001）和生活方式改变（OR 8.39；95%CI 3.26 至 21.55；p<0.001）与 HbA1c 降低的可能性更大相关，而糖尿病药物不依从（OR 0.014；95%CI 0.0025 至 0.085；p<0.001）和停用非胰岛素糖尿病药物（OR 0.30；95%CI 0.11 至 0.80；p=0.016）与胰岛素治疗下降后 HbA1c 降低的可能性降低相关。
我们确定了与患者停用胰岛素治疗后血糖控制成功和失败相关的患者特征和治疗策略。这些信息可以为这些患者选择最佳治疗方法提供帮助。
