Monanabela Khathatso B, van Huyssteen Mea, Coetzee Renier
School of Pharmacy, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa.
Health SA. 2019 Oct 16;24:1051. doi: 10.4102/hsag.v24i0.1051. eCollection 2019.
Rational medicine use aims to optimise chronic disease management and prevent episodes of hospitalisation that economically burden the health care system. Diabetes mellitus is one of the most prevalent chronic diseases globally, yet more than 60% of patients with diabetes are not optimally managed according to their therapeutic glycaemic targets.
To describe the use of glycated haemoglobin (HbA1c) and fasting plasma glucose results in guiding treatment changes in patients with type 2 diabetes mellitus.
Public sector primary health care facilities in the Cape Town Metropolitan Region in South Africa.
Retrospective, descriptive study design was employed. Data for an 18-month period were collected during 2014 and 2015. Data were collected from patient medical records and included baseline demographics, laboratory monitoring tests and the patients' last three prescriptions.
The study consisted of 575 participants (64% female) with an average age of 57 (± 11.38) years. The average baseline HbA1c for 493 participants with at least one result was 8.78% (± 1.63), and only 28% of these participants reached the glycaemic target at consequent consultations. HbA1c levels were available to guide 245 prescription changes, of which 181 of these results were outside of the target range. Of these, 15.5% had appropriate therapy adjustments, 78.4% had no change or a lateral change in their follow-up prescriptions, and 6.1% had therapy adjustments opposite to what guidelines suggest.
Glycaemic monitoring indicated consistent suboptimal glycaemic control in more than 60% of participants. Medicine prescribing patterns did not align with the prescribed local guidelines, Society for Metabolism, Endocrinology and Diabetes of South Africa (SEMDSA). The appropriate use and interpretation of HbA1c at a clinic level should be emphasised to promote rational use of medicines that minimise acute hospitalisation episodes and optimise patients' long-term health outcomes.
合理用药旨在优化慢性病管理，并预防给医疗保健系统带来经济负担的住院情况。糖尿病是全球最常见的慢性病之一，但超过60%的糖尿病患者未根据其治疗血糖目标得到最佳管理。
描述糖化血红蛋白（HbA1c）和空腹血糖结果在指导2型糖尿病患者治疗调整中的应用。
南非开普敦都会区的公共部门初级卫生保健机构。
采用回顾性描述性研究设计。2014年和2015年收集了为期18个月的数据。数据从患者病历中收集，包括基线人口统计学信息、实验室监测检查以及患者的最后三张处方。
该研究包括575名参与者（64%为女性），平均年龄为57（±11.38）岁。493名至少有一次结果的参与者的平均基线HbA1c为8.78%（±1.63），在随后的会诊中，只有28%的参与者达到了血糖目标。有HbA1c水平可用于指导245次处方变更，其中181次结果超出目标范围。在这些结果中，15.5%进行了适当的治疗调整，78.4%在后续处方中没有变化或进行了横向变更，6.1%的治疗调整与指南建议相反。
血糖监测表明，超过60%的参与者血糖控制持续未达最佳水平。用药处方模式与南非代谢、内分泌和糖尿病学会（SEMDSA）规定的当地指南不一致。应强调在诊所层面正确使用和解读HbA1c，以促进合理用药，尽量减少急性住院情况并优化患者的长期健康结果。
