Department of pharmacy, CHU Nîmes, university Montpellier, Nîmes, France.
Department of diabetes, endocrine and metabolic medicine, CHU Nîmes, university Montpellier, Nîmes, France.
Ann Pharm Fr. 2022 Nov;80(6):827-836. doi: 10.1016/j.pharma.2022.05.001. Epub 2022 May 11.
In the management of diabetic patients on insulin therapy, adherence to medication is a key element for avoiding chronic complications. The purpose of this study was to evaluate diabetic patients' ability to translate glycemic results into an appropriate insulin dose and thus, adherence to insulins.
This was an observational, retrospective, monocentric pilot study. Diabetic patients on insulin therapy being followed at the metabolic and endocrine diseases department were divided into two groups depending on their mode of glycemic control at home: capillary glycemia (Notebook group) or interstitial glycemia using the FreeStyle Libre® flash system (FSL group). Adherence was assessed based on the rate of compliance in adapting insulin doses to the prescribed protocols (depending on type of insulin, glycemic targets, and patients' characteristics) by a pharmacy resident and a senior diabetologist. Good adherence was defined as a minimum rate of 80% of conforming insulin injections for each patient.
A total of 50 patients were included, 35 in the Notebook group and 15 in the FSL group. Two-thirds of patients were non-adherent to insulin. Dose adjustment errors mainly concerned rapid-acting insulin with 51.1% of non- conformities, 10.0% of which were due to underdosing in the Notebook group and 21.7% to overdosing in the FSL group. Hyperglycemia was predominant in both populations with a median time in range of 19.0% in the FSL group and well below recommendations (>70%).
Despite the use of increasingly efficient, easy-to-use devices in diabetes monitoring, insulin non-adherence and glycemic imbalance are unresolved major issues. Diabetic patients require reinforced medical follow-up for optimal insulin management.
在接受胰岛素治疗的糖尿病患者管理中，坚持用药是避免慢性并发症的关键因素。本研究旨在评估糖尿病患者将血糖结果转化为适当胰岛素剂量的能力，从而评估其对胰岛素的依从性。
这是一项观察性、回顾性、单中心的试点研究。根据在家中血糖控制的方式（毛细血管血糖[笔记本组]或使用 FreeStyle Libre® flash 系统的间质血糖[FSL 组]），将接受胰岛素治疗的糖尿病患者分为两组。根据药房住院医师和高级糖尿病专家评估的调整胰岛素剂量以适应规定方案的顺应率（取决于胰岛素类型、血糖目标和患者特征）来评估依从性。良好的依从性定义为每位患者至少有 80%的胰岛素注射符合规定。
共纳入 50 例患者，其中笔记本组 35 例，FSL 组 15 例。三分之二的患者对胰岛素不依从。剂量调整错误主要涉及速效胰岛素，其中 51.1%不符合要求，笔记本组中有 10.0%是由于剂量不足，FSL 组中有 21.7%是由于剂量过高。两种人群均以高血糖为主，FSL 组的达标时间中位数为 19.0%，远低于推荐值（>70%）。
尽管在糖尿病监测中使用了越来越高效、易用的设备，但胰岛素不依从和血糖失衡仍然是未解决的主要问题。糖尿病患者需要加强医疗随访，以实现最佳胰岛素管理。
