DRK children`s hospital Siegen, Siegen, Germany.
Diabetologische Schwerpunktpraxis, Frankfurt, Germany.
Diabet Med. 2020 Aug;37(8):1333-1339. doi: 10.1111/dme.14338. Epub 2020 Jul 1.
To evaluate how many people with type 2 diabetes receive a treatment regimen with insulin as a first-line therapy and the factors associated with this.
This retrospective study was based on data from the Disease Analyzer database and included 10 497 people with type 2 diabetes with an initial prescription of anti-hyperglycaemic therapy from 859 general and diabetologist practices in Germany between January 2014 and December 2018. The main outcome of the study was the prevalence of insulin as a first-line therapy. A multivariable logistic regression model was performed to investigate the association between predefined variables and the probability of receiving insulin as a first-line therapy.
A total of 7.1% of participants received insulin as a first-line therapy. Diabetologist practice [odds ratio (OR) 2.71, 95% confidence interval (CI) 1.81-4.06], age > 80 years (OR 2.35, 95% CI 1.20-4.61) compared with age ≤ 40 years, HbA ≥ 86 mmol/mol (10%) (OR 2.99, 95% CI 1.81-4.95) compared with HbA < 48 mmol/mol (6.5%), renal complications (OR 1.91, 95% CI 1.29-2.81), peripheral artery disease (OR 1.94, 95% CI 1.30-2.81), neurological complications (OR 1.45, 95% CI 1.00-2.09), Charlson Comorbidity Index (OR 1.16, 95% CI 1.08-1.25) and higher number of different drugs prescribed within 12 months prior-the index date (OR 1.09, 95% CI 1.05-1.12) were significantly associated with the probability of receiving insulin as a first-line therapy.
Insulin is rarely used as a first-line therapy in people with type 2 diabetes. Furthermore, a person's likelihood of receiving insulin as a first-line therapy is significantly influenced by diabetologist practice, age, HbA ≥ 86 mmol/mol (10%), renal, neurological and vascular complications, higher multimorbidity, and polypharmacy.
评估有多少 2 型糖尿病患者接受胰岛素作为一线治疗方案，以及与该方案相关的因素。
这是一项回顾性研究，基于来自德国 859 家综合和糖尿病专科诊所的数据，纳入了 2014 年 1 月至 2018 年 12 月间首次开具抗高血糖治疗处方的 10497 名 2 型糖尿病患者。研究的主要结局为胰岛素作为一线治疗方案的流行率。采用多变量逻辑回归模型，研究了预定义变量与接受胰岛素作为一线治疗方案的概率之间的关联。
共有 7.1%的参与者接受胰岛素作为一线治疗方案。与 40 岁以下患者相比，糖尿病专科诊所（比值比 [OR] 2.71，95%置信区间 [CI] 1.81-4.06）、年龄>80 岁（OR 2.35，95%CI 1.20-4.61）、糖化血红蛋白 [HbA]≥86mmol/mol（10%）（OR 2.99，95%CI 1.81-4.95）与 HbA<48mmol/mol（6.5%）、肾脏并发症（OR 1.91，95%CI 1.29-2.81）、外周动脉疾病（OR 1.94，95%CI 1.30-2.81）、神经并发症（OR 1.45，95%CI 1.00-2.09）、Charlson 合并症指数（OR 1.16，95%CI 1.08-1.25）和索引日期前 12 个月内开具的不同药物数量增加（OR 1.09，95%CI 1.05-1.12）与接受胰岛素作为一线治疗方案的概率显著相关。
在 2 型糖尿病患者中，胰岛素很少作为一线治疗方案使用。此外，患者接受胰岛素作为一线治疗方案的可能性显著受到糖尿病专科诊所、年龄、HbA≥86mmol/mol（10%）、肾脏、神经和血管并发症、合并症较高和多药治疗的影响。
