血糖管理三人行项目中2型糖尿病患者的用药依从性

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摘要目的：调查和分析“血糖管理三人行项目”中2型糖尿病患者的用药依从性。方法：对温州医科大学附属第一医院243例参加“血糖管理三人行项目”的2型糖尿病患者，按12周随访期间是否停药分为停药组与未停药组，对2组人群在使用基础胰岛素前的一般情况及临床特征进行对比，并用多元logistic回归模型进一步分析；同时观察在停药组患者中12周随访期结束前不同的停药原因及患者停药时间分布情况、不同的既往治疗方案中患者停药的原因及不同的目前治疗方案中患者停药的原因。结果：与未停药组患者相比，停药组患者男性所占比例较高，年龄相对较小，BMI较高，病程较短，初始空腹血糖、初始胰岛素剂量较低，全身并发症情况较少（均P＜0.05）。在停药组中,第1周停药人数最多,停药原因主要是更改治疗方案-只用口服降糖药。多元logistic回归模型分析结果显示，病程较短、初始空腹血糖较高、BMI较高及初始胰岛素剂量较低是本组患者停药的影响因素（均P＜0.05），其中病程较短是影响患者用药依从性的最重要因素（P＜0.001）。结论：“血糖管理三人行项目”对于病程较短、初始空腹血糖较高、BMI较高及初始胰岛素剂量较低患者的用药依从性较差，停药主要原因是更改治疗方案-只用口服降糖药。

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	沈雯
	周玲丽
	蒋自培

关键词 ： 2型糖尿病, 血糖管理, 用药依从性

Abstract：Objective: To investigate and analyze the medication compliance of type 2 diabetes mellitus patients. Method: A total of 243 patients with type 2 diabetes in the First Affiliated Hospital of Wenzhou Medical University who participated in the “glucose optimization management project” (launched by the Chinese Medical Doctor Association and Sanofi) were divided into two groups depending on whether they had stopped taking drugs during the 12-week follow-up period. The general situation and clinical characteristics of the two groups before the use of basic insulin were compared and further analyzed by multiple logistic regression model. The differences between the two groups before the end of the 12-week follow-up period were observed. The causes of drug withdrawal and the distribution of time of drug withdrawal, the causes of drug withdrawal in different previous treatment schemes and the causes of drug withdrawal in different current treatment schemes were analyzed. Results: Compared with the group without discontinuation, the discontinuation group was found to have higher proportion of males, younger age, higher body mass index (BMI), shorter course of disease, lower initial fasting blood glucose and insulin dosage and fewer systemic complications (all P<0.05). In the discontinuation group, the number of discontinuation was the largest in the first week. The main reason for discontinuation was to change the treatment plan into oral hypoglycemic drugs only. Multivariate logistic regression analysis showed that shorter course of disease, higher initial fasting blood glucose, higher BMI and lower initial insulin dosage were the influencing factors of drug withdrawal (P<0.05), and shorter course of disease was the most important influencing factor (P<0.001). Conclusion: In the glucose optimization management project, poor compliance with medication occurred in patients with shorter course of disease, higher initial fasting blood glucose, higher BMI and lower initial insulin dosage. The main reason for discontinuation is to change the treatment plan into taking oral hypoglycemic drugs only.

Key words： diabetes mellitus, type 2 blood glucose management drug compliance

收稿日期: 2018-12-17

通讯作者: 蒋自培，副主任医师，Email：jzp20012000@163.com。

作者简介: 沈雯（1976-），女，安徽马鞍山人，护师。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2019/V49/I5/376

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