Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
Diabetes Care. 2020 Jun;43(6):1227-1233. doi: 10.2337/dc19-2424. Epub 2020 Mar 31.
) To examine trends in the use of diabetes medications and ) to determine whether physicians individualize diabetes treatment as recommended by the American Diabetes Association (ADA).
We conducted a retrospective, cross-sectional analysis of 2003-2016 National Health and Nutrition Examination Survey (NHANES) data. We included people ≥18 years who had ever been told they had diabetes, had an HbA >6.4%, or had a fasting plasma glucose >125 mg/dL. Pregnant women and patients aged <20 years receiving only insulin were excluded. We assessed trends in use of ADA's seven preferred classes from 2003-2004 to 2015-2016. We also examined use by hypoglycemia risk (sulfonylureas, insulin, and meglitinides), weight effect (sulfonylureas, thiazolidinediones [TZDs], insulin, and meglitinides), cardiovascular benefit (canagliflozin, empagliflozin, and liraglutide), and cost (brand-name medications and insulin analogs).
The final sample included 6,323 patients. The proportion taking any medication increased from 58% in 2003-2004 to 67% in 2015-2016 ( < 0.001). Use of metformin and insulin analogs increased, while use of sulfonylureas, TZDs, and human insulin decreased. Following the 2012 ADA recommendation, the choice of drug did not vary significantly by older age, weight, or presence of cardiovascular disease. Patients with low HbA, or HbA <6%, and age ≥65 years were less likely to receive hypoglycemia-inducing medications, while older patients with comorbidities were more likely. Insurance, but not income, was associated with the use of higher-cost medications.
Following ADA recommendations, the use of metformin increased, but physicians generally did not individualize treatment according to patients' characteristics. Substantial opportunities exist to improve pharmacologic management of diabetes.
）检查糖尿病药物使用趋势，并）确定医生是否根据美国糖尿病协会（ADA）的建议对糖尿病治疗进行个体化。
我们对 2003-2016 年全国健康和营养调查（NHANES）数据进行了回顾性、横断面分析。我们纳入了年龄≥18 岁、曾被告知患有糖尿病、HbA >6.4%或空腹血糖>125mg/dL 的人群。排除孕妇和仅接受胰岛素治疗、年龄<20 岁的患者。我们评估了 2003-2004 年至 2015-2016 年 ADA 推荐的七种首选药物类别使用的趋势。我们还检查了低血糖风险（磺酰脲类药物、胰岛素和格列奈类药物）、体重效应（磺酰脲类药物、噻唑烷二酮类药物[TZDs]、胰岛素和格列奈类药物）、心血管益处（卡格列净、恩格列净和利拉鲁肽）和成本（品牌药物和胰岛素类似物）的使用情况。
最终样本包括 6323 名患者。服用任何药物的比例从 2003-2004 年的 58%增加到 2015-2016 年的 67%（<0.001）。二甲双胍和胰岛素类似物的使用增加，而磺酰脲类药物、TZDs 和人胰岛素的使用减少。ADA 2012 年的建议后，药物选择与年龄较大、体重或存在心血管疾病无关。HbA 较低或<6%且年龄≥65 岁的患者不太可能接受引起低血糖的药物，而合并症较多的老年患者则更有可能。保险而不是收入与使用成本较高的药物有关。
ADA 建议后，二甲双胍的使用增加，但医生通常没有根据患者的特征进行个体化治疗。改善糖尿病药物管理有很大的机会。
