2 型糖尿病门诊患者药物依从性的生化尿液检测及其与临床标志物的关系：在糖尿病和生活方式队列特温特研究（DIALECT）中的分析。
Biochemical Urine Testing of Medication Adherence and Its Association With Clinical Markers in an Outpatient Population of Type 2 Diabetes Patients: Analysis in the DIAbetes and LifEstyle Cohort Twente (DIALECT).
机构信息
Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands
Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands.
出版信息
Diabetes Care. 2021 Jun;44(6):1419-1425. doi: 10.2337/dc20-2533. Epub 2021 Apr 23.
OBJECTIVE
To assess adherence to the three main drug classes in real-world patients with type 2 diabetes using biochemical urine testing, and to determine the association of nonadherence with baseline demographics, treatment targets, and complications.
RESEARCH DESIGN AND METHODS
Analyses were performed of baseline data on 457 patients in the DIAbetes and LifEstyle Cohort Twente (DIALECT) study. Adherence to oral antidiabetics (OADs), antihypertensives, and statins was determined by analyzing baseline urine samples using liquid chromatography-tandem mass spectrometry. Primary outcomes were microvascular and macrovascular complications and treatment targets of LDL cholesterol, HbA, and blood pressure. These were assessed cross-sectionally at baseline.
RESULTS
Overall, 89.3% of patients were identified as adherent. Adherence rates to OADs, antihypertensives, and statins were 95.7%, 92.0%, and 95.5%, respectively. The prevalence of microvascular (81.6% vs. 66.2%; = 0.029) and macrovascular complications (55.1% vs. 37.0%; = 0.014) was significantly higher in nonadherent patients. The percentage of patients who reached an LDL cholesterol target of ≤2.5 mmol/L was lower (67.4% vs. 81.1%; = 0.029) in nonadherent patients. Binary logistic regression indicated that higher BMI, current smoking, elevated serum LDL cholesterol, high HbA, presence of diabetic kidney disease, and presence of macrovascular disease were associated with nonadherence.
CONCLUSIONS
Although medication adherence of real-world type 2 diabetes patients managed in specialist care was relatively high, the prevalence of microvascular and macrovascular complications was significantly higher in nonadherent patients, and treatment targets were reached less frequently. This emphasizes the importance of objective detection and tailored interventions to improve adherence.
目的
通过生化尿液检测评估 2 型糖尿病真实世界患者对三大类药物的依从性，并确定不依从与基线人口统计学、治疗目标和并发症的关系。
研究设计和方法
对 DIAbetes 和 LifEstyle Cohort Twente（DIALECT）研究中的 457 名患者的基线数据进行了分析。通过液相色谱-串联质谱法分析基线尿液样本，确定口服降糖药（OADs）、抗高血压药和他汀类药物的依从性。主要结局是微血管和大血管并发症以及 LDL 胆固醇、HbA 和血压的治疗目标。这些在基线时进行横断面评估。
结果
总体而言，89.3%的患者被确定为依从。OADs、抗高血压药和他汀类药物的依从率分别为 95.7%、92.0%和 95.5%。不依从患者的微血管（81.6%比 66.2%； = 0.029）和大血管并发症（55.1%比 37.0%； = 0.014）的患病率明显更高。未达到 LDL 胆固醇目标≤2.5mmol/L 的患者比例（67.4%比 81.1%； = 0.029）也较低。二元逻辑回归表明，较高的 BMI、当前吸烟、血清 LDL 胆固醇升高、高 HbA、糖尿病肾病和大血管疾病的存在与不依从有关。
结论
尽管专科治疗管理的 2 型糖尿病患者的药物依从性相对较高，但不依从患者的微血管和大血管并发症患病率明显更高，且治疗目标的达标率较低。这强调了客观检测和针对性干预以提高依从性的重要性。
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