Gimeno Esteban J, Bøgelund Mette, Larsen Sara, Okkels Anna, Reitzel Signe B, Ren Hongye, Orozco-Beltran Domingo
Faculty of Medicine, Universidad Europea de Madrid, Madrid, Spain.
EY Economics, Dirch Passers Allé 36, 2000, Frederiksberg, Denmark.
Diabetes Ther. 2024 May;15(5):1047-1067. doi: 10.1007/s13300-024-01559-w. Epub 2024 Mar 23.
Diabetes is associated with a number of complications, particularly if glycaemic targets are not achieved. Glycaemic control is highly linked to treatment persistence and adherence. To understand the burden of poor persistence and adherence, this systematic literature review identified existing evidence regarding basal insulin adherence/non-adherence and persistence/non-persistence among people with diabetes in Western Europe (defined as the UK, France, Spain, Switzerland, the Netherlands, Ireland, Austria, Portugal, Denmark, Norway, Sweden, Finland, Italy, Germany, Iceland and Belgium).
Eligible studies were systematically identified from two databases, Medline and Embase (published between 2012 and June 2022). Conference abstracts from ISPOR and EASD were manually included. Identified studies were screened by two independent reviewers in a two-step blinded process. The eligibility of studies was decided on the basis of pre-established criteria. A proportional meta-analysis and comparative narrative analyses were conducted to analyse the included studies.
Twelve studies were identified. Proportions of adherence/non-adherence and persistence/non-persistence varied across studies. Pooled rates of non-persistence at 6, 12 and 18 months were 20.3% (95% CI 13.8; 27.8), 33.8% (95% CI 24.1; 44.3) and 36.5% (95% CI 33.6; 39.4), respectively. In the literature, the proportion of adherent people ranged from 41% to 64% (using the outcome measure medication possession ratio (MPR) > 80%), with a pooled rate of 55.6% (95% CI 45.3; 65.6), suggesting that approximately 44% of people with type 2 diabetes (T2D) are non-adherent.
The results highlight that almost half of patients with T2D in Western Europe have poor adherence to insulin therapy and, at 18 months, one in three patients do not persist on treatment. These findings call for new basal insulin therapies and diabetes management strategies that can improve treatment persistence and adherence among people with T2D.
糖尿病与多种并发症相关，尤其是在未实现血糖目标的情况下。血糖控制与治疗依从性和持续性密切相关。为了解依从性和持续性不佳所带来的负担，本系统文献综述确定了有关西欧糖尿病患者基础胰岛素治疗依从性/不依从性和持续性/非持续性的现有证据（西欧定义为英国、法国、西班牙、瑞士、荷兰、爱尔兰、奥地利、葡萄牙、丹麦、挪威、瑞典、芬兰、意大利、德国、冰岛和比利时）。
从两个数据库Medline和Embase（2012年至2022年6月发表）中系统识别符合条件的研究。手动纳入来自国际药效经济学和结果研究协会（ISPOR）和欧洲糖尿病研究协会（EASD）的会议摘要。由两名独立评审员在两步盲法过程中对识别出的研究进行筛选。根据预先设定的标准确定研究的 eligibility。进行了比例荟萃分析和比较叙述性分析以分析纳入的研究。
共识别出12项研究。各研究中依从性/不依从性和持续性/非持续性的比例各不相同。6个月、12个月和18个月时的非持续性合并率分别为20.3%（95%置信区间13.8；27.8）、33.8%（95%置信区间24.1；44.3）和36.5%（95%置信区间33.6；39.4）。在文献中，依从者的比例范围为41%至64%（使用服药持有率（MPR）>80%作为结局指标），合并率为55.6%（95%置信区间45.3；65.6），这表明约44%的2型糖尿病（T2D）患者不依从治疗。
结果表明，西欧近一半的T2D患者胰岛素治疗依从性差，在18个月时，三分之一的患者未坚持治疗。这些发现呼吁开发新的基础胰岛素疗法和糖尿病管理策略，以提高T2D患者的治疗持续性和依从性。
