Dumont Cyndi, Fitzgerald Leah, Valdez Connie A
University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
J Prim Care Community Health. 2020 Jan-Dec;11:2150132720973827. doi: 10.1177/2150132720973827.
The objective of this quality assurance study is to evaluate the impact of a conservative, pharmacist-led, U-500R insulin management protocol on diabetes control (A1c) and total daily dosage requirements between August 2016 and August 2018.
This was a retrospective chart review of adult patients, aged 18 to 79, with type 2 diabetes and managed with insulin, at 2 federally qualified healthcare clinics in Denver, Colorado. To determine if our conservative pharmacist-led U-500R insulin management protocol impacted efficacy and total daily dosage requirements when converting patients from U-100 to U-500R insulin, we compared the most effective dose of U-500R (defined as the total daily dose (TDD) of U-500R insulin at A1c goal or the lowest tolerated A1c) to the baseline A1c and TDD of U-100 insulin at time of conversion.
Following conversion of U-100 to U-500R insulin, patients required an average of 21 fewer units of insulin with U-500R than U-100 and achieved an average A1c of 7.2% which reflected a reduction of 3.5 points from baseline. Five patients (62.5%) achieved A1c goal per ADA guidelines, and all patients achieved at least a 1.7 point reduction in A1c, with 1 patient achieving a 6.7 point reduction. Two patients (25%) were still in the process of U-500R titration at the time of data collection, and 1 patient (12.5%) did not achieve goal A1c while under pharmacy management at these clinics. Four of the five patients who achieved A1c goal did so with an overall reduction in total daily insulin dose (average of 57.5 units less than original U-100 dose) resulting in an average A1c decrease of 3.6 points.
本质量保证研究的目的是评估2016年8月至2018年8月期间，由药剂师主导的保守型U-500R胰岛素管理方案对糖尿病控制情况（糖化血红蛋白）以及每日总剂量需求的影响。
这是一项对科罗拉多州丹佛市两家联邦合格医疗诊所中年龄在18至79岁、患有2型糖尿病且使用胰岛素治疗的成年患者进行的回顾性病历审查。为了确定我们由药剂师主导的保守型U-500R胰岛素管理方案在将患者从U-100胰岛素转换为U-500R胰岛素时是否会影响疗效和每日总剂量需求，我们将U-500R的最有效剂量（定义为达到糖化血红蛋白目标时的U-500R胰岛素每日总剂量（TDD）或最低耐受糖化血红蛋白）与转换时U-100胰岛素的基线糖化血红蛋白和TDD进行了比较。
将U-100胰岛素转换为U-500R胰岛素后，患者使用U-500R胰岛素的平均剂量比U-100胰岛素少21单位，平均糖化血红蛋白为7.2%，较基线降低了3.5个百分点。5名患者（62.5%）根据美国糖尿病协会指南达到了糖化血红蛋白目标，所有患者的糖化血红蛋白至少降低了1.7个百分点，其中1名患者降低了6.7个百分点。在数据收集时，有2名患者（25%）仍在进行U-500R胰岛素滴定，1名患者（12.5%）在这些诊所接受药房管理期间未达到糖化血红蛋白目标。达到糖化血红蛋白目标的5名患者中有4名患者的每日胰岛素总剂量总体减少（平均比原来的U-100剂量少57.5单位），导致糖化血红蛋白平均降低3.6个百分点。
