Kanumilli Naresh, Brunton Stephen, Cos Xavier, Deed Gary, Kushner Pamela, Lin Peter, Nolte Johannes
Community Diabetes Consultant, Manchester University Foundation Trust, UK; GPSi Diabetes and Cardiology, Northenden Group Practice, Manchester, UK.
Primary Care Metabolic Group, Los Angeles, CA, USA.
J Diabetes Complications. 2021 Mar;35(3):107813. doi: 10.1016/j.jdiacomp.2020.107813. Epub 2020 Nov 26.
To explore reasons behind treatment inertia in current approaches to early cardiorenal risk management in type 2 diabetes (T2D).
A global, web-based, quantitative panel survey of primary care physicians (PCPs) and primary care diabetes specialists treating people living with T2D. The questions covered current management of T2D, particularly the use of sodium-glucose co-transporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl peptidase-4 inhibitors as second-/third-line therapies.
Of 1677 respondents from 18 countries who completed the survey, 73.4% were responsible for second-/third-line therapy initiation. Two thirds had modified treatment decisions based on recent cardiovascular outcomes trials (CVOTs). Respondents cited restricted access to therapies and limits on regular appointments as the greatest barriers to second-/third-line therapy prescription. Although 81.6% agreed that early intensification to second-/third-line therapies is associated with clinical benefits, 46.1% of respondents still reserve these for later lines of therapy, and 23.8% would not consider changing therapeutic approach in patients with well-controlled T2D but increasing cardiovascular risk.
Substantial barriers still prevent optimization of primary setting T2D patient care. Education programs which enable PCPs to translate CVOT evidence into clinical benefits for patients with T2D could address many of the remaining knowledge gaps identified.
探讨2型糖尿病（T2D）早期心肾风险管理当前方法中治疗惰性背后的原因。
对治疗T2D患者的基层医疗医生（PCP）和基层糖尿病专科医生进行一项基于网络的全球定量问卷调查。问题涵盖T2D的当前管理，特别是钠-葡萄糖协同转运蛋白2抑制剂、胰高血糖素样肽-1受体激动剂和二肽基肽酶-4抑制剂作为二线/三线治疗的使用情况。
在来自18个国家的1677名完成调查的受访者中，73.4%负责启动二线/三线治疗。三分之二的人根据近期心血管结局试验（CVOT）修改了治疗决策。受访者指出，获得治疗的机会受限和定期预约的限制是二线/三线治疗处方的最大障碍。尽管81.6%的人同意早期强化至二线/三线治疗具有临床益处，但46.1%的受访者仍将这些治疗保留用于后续治疗线，23.8%的人不会考虑在T2D控制良好但心血管风险增加的患者中改变治疗方法。
仍然存在重大障碍阻碍了T2D患者基层医疗护理的优化。能够使基层医疗医生将CVOT证据转化为T2D患者临床益处的教育项目可以解决所发现的许多剩余知识差距。
