社区居住的2型糖尿病老年患者抗糖尿病和心血管预防药物的处方模式：一项横断面研究。
Prescription patterns of antidiabetic and cardiovascular preventive medications in community-dwelling older adults with type 2 diabetes mellitus: a cross-sectional study.
作者信息
Chahine Bahia, Souheil Farah Al, Hanna Venise
机构信息
Lebanese International University, School of Pharmacy, Beirut, Lebanon.
出版信息
J Geriatr Cardiol. 2023 Dec 28;20(12):867-876. doi: 10.26599/1671-5411.2023.12.002.
OBJECTIVE
To describe trends in antidiabetics drug prescription patterns in community-dwelling older adults with type 2 diabetes mellitus (T2DM) and to evaluate the use of cardiovascular preventive medications among those diagnosed with atherosclerotic cardiovascular disease (ASCVD).
METHODS
This cross-sectional, face-to-face interview study that comprised community-dwelling older adults (≥ 65 years) diagnosed with T2DM. The study questionnaire included the patients' demographics, clinical data, and current medication use. Patients with established ASCVD were further classified into low (i.e., not receiving evidence-based therapy or only one) and high (i.e., receiving at least two evidence-based therapies) composite score groups. Bivariate analysis followed by multivariable logistic regression analysis were performed to evaluate the demographic/clinical characteristics associated with the use of antidiabetic monotherapy/polytherapy and evidence-based pharmacotherapy.
RESULTS
A total of 500 older adults were enrolled. The mean age of included participants was 73 ± 7 years, 310 participants (62%) were males, and 385 participants (77.0%) had established ASCVD. Antidiabetic monotherapy was reported in 251 participants (50.2%), with metformin followed by sulfonylureas being the most commonly prescribed drugs as monotherapy. The results of the multivariable analysis showed that age [odds ratio (OR) = 0.89, 95% CI: 0.85-0.94, < 0.001], obesity (OR = 4.18, 95% CI: 1.63-10.36, = 0.003), hypertension (OR = 4.2, 95% CI: 1.22-7.66, = 0.04), and dyslipidemia (OR = 4.1, 95% CI: 1.28-8.30, = 0.01), were significantly associated with the prescription of cardiovascular preventive medications.
CONCLUSIONS
Only one in twenty-one participant with T2DM and ASCVD collectively received three guideline-recommended therapies, indicating a deficiency of utilization of cardiovascular preventive drugs.
目的
描述社区居住的2型糖尿病（T2DM）老年患者抗糖尿病药物处方模式的趋势，并评估那些被诊断为动脉粥样硬化性心血管疾病（ASCVD）的患者使用心血管预防药物的情况。
方法
这项横断面面对面访谈研究纳入了社区居住的≥65岁且被诊断为T2DM的老年人。研究问卷包括患者的人口统计学信息、临床数据和当前用药情况。已确诊ASCVD的患者进一步分为低（即未接受基于证据的治疗或仅接受一种治疗）和高（即接受至少两种基于证据的治疗）综合评分组。进行双变量分析，随后进行多变量逻辑回归分析，以评估与使用抗糖尿病单药治疗/联合治疗和基于证据的药物治疗相关的人口统计学/临床特征。
结果
共纳入500名老年人。纳入参与者的平均年龄为73±7岁，310名参与者（62%）为男性，385名参与者（77.0%）已确诊ASCVD。251名参与者（50.2%）报告使用抗糖尿病单药治疗，其中二甲双胍之后是磺脲类药物，是最常用的单药治疗药物。多变量分析结果显示，年龄[比值比（OR）=0.89，95%置信区间：0.85-0.94，P<0.001]、肥胖（OR=4.18，95%置信区间：1.63-10.36，P=0.003）、高血压（OR=4.2，95%置信区间：1.22-7.66，P=0.04）和血脂异常（OR=4.1，95%置信区间：1.28-8.30，P=0.01）与心血管预防药物的处方显著相关。
结论
在患有T2DM和ASCVD的参与者中，只有二十一分之一的人同时接受了三种指南推荐的治疗，这表明心血管预防药物的使用存在不足。
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