2型糖尿病患者治疗过程中的临床惰性及其影响因素:一项多中心观察性研究结果  

Clinical inertia and associated factors in the treatment of type 2 diabetes patients:an analysis from a multicenter study

作　　者：李翔 许樟荣 朱大龙[2] 刘静[3] 徐玉善[4] 贾伟平[5] 纪立农[6] 陈莉明[7] 冉兴无[8] 单忠燕 郭立新[10] 翁建平[11] 曾龙驿[11] 冯琨[12] 周智广[13] 施秉银[14] 赵湜[15] 朱筠[16] 陆祖谦 Li Xiang;Xu Zhangrong;Zhu Dalong;Liu Jing;Xu Yushan;Jia Weiping;Ji Linong;Chen Liming;Ran Xingwu;Shan Zhongyan;Guo Lixin;Weng Jianping;Zeng Longyi;Feng Kun;Zhou Zhiguang;Shi Bingyin;Zhao Shi;Zhu Jun;Lu Zuqian(Department of Endocrinology,Strategic Support Force Characteristic Medical Center,Beijing 100101,China;Department of Endocrinology,Nanjing Drum Tower Hospital,the Affilated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Endocrinology,Gansu Provincial Hospital,Lanzhou 730000,China;Department of Endocrinology,First Affiliated Hospital of Kunming Medical University,Kunming 620032,China;Department of Endocrinology,Shanghai Jiao Tong University Affiliated Sixth People′s Hospital,Shanghai 200233,China;Department of Endocrinology,Peking University People′s Hospital,Beijing 100044,China;Department of Endocrinology,Tianjin Medical University Metabolic Diseases Hospital,Tianjin 300070,China;Department of Endocrinology,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Endocrinology,the First Affiliated Hospital of China Medical University,Shenyang 110001,China;Department of Endocrinology,Beijing Hospital,Beijing 100730,China;Department of Endocrinology and Metabolism,the Third Affiliated Hospital,Sun Yat-Sen University,Guangzhou 510630,China;Department of Endocrinology,Heilongjiang Provincial Hospital,Harbin 150030,China;Department of Endocrinology,the Second Xiangya Hospital of Central South University,Changsha 410011,China;Department of Endocrinology,the First Affiliated Hospital of Xi′an Jiao Tong University,Xi′an 710061,China;Department of Endocrinology,Tongji Medical College Huazhong University of Science and Technology,the Central Hospital of Wuhan,Wuhan 430014,China;Department of Endocrinology,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]战略支援部队特色医学中心内分泌科,北京100101 [2]南京大学医学院附属鼓楼医院内分泌科,210008 [3]甘肃省人民医院内分泌科,兰州730000 [4]昆明医科大学第一附属医院内分泌科,620032 [5]上海交通大学附属第六人民医院内分泌科,200233 [6]北京大学人民医院内分泌科,100044 [7]天津医科大学代谢病医院内分泌科,300070 [8]四川大学华西医院内分泌科,成都610041 [9]中国医科大学附属第一医院内分泌科,沈阳110001 [10]北京医院内分泌科,100730 [11]中山医科大学附属第三医院内分泌科,广州510630 [12]黑龙江省医院内分泌科,哈尔滨150030 [13]中南大学湘雅二院内分泌科,长沙410011 [14]西安交通大学第一附属医院内分泌科,710061 [15]华中科技大学同济医学院,武汉市中心医院内分泌科,430014 [16]新疆医科大学第一附属医院内分泌科,乌鲁木齐830054

出　　处：《中华糖尿病杂志》2020年第2期81-85,共5页CHINESE JOURNAL OF DIABETES MELLITUS

摘　　要：目的了解通过生活方式干预和口服药物治疗的2型糖尿病(T2DM)患者治疗过程中的临床惰性并分析其影响因素。方法2015年3至5月对"中国城市三级甲等医院T2DM费用调查研究"中基线糖化血红蛋白(HbA1c)≥7.0%的患者进行随访,6个月后了解患者药物治疗情况,如6个月后治疗方案未做升级,即未增加≥1种的口服降糖药物、未起始胰岛素或未起始胰高糖素样肽-1(GLP-1)受体激动剂即被视为临床惰性。采用logistic回归模型进行多变量分析以识别临床惰性的独立预测因素。结果共纳入T2DM患者178例,其中男101例(56.7%),女77例(43.3%),年龄(58±11)岁,糖尿病病程(7±7)年,HbA1c(8.6±1.6)%。T2DM患者总体临床惰性发生率为52.2%(93/178),增加口服降糖药物种类、起始胰岛素或者起始GLP-1受体激动剂的比例分别为30.9%(55/178)、16.3%(29/178)和0.6%(1/178)。临床惰性的影响因素包括HbA1c7.5%~8.9%(OR=3.437,95%CI:1.421~8.309)和HbA1c≥9.0%(OR=9.738,95%CI:3.634~26.901)、糖尿病视网膜病变(OR=2.732,95%CI:1.004~7.431)、使用两种以上口服药物(OR=2.651,95%CI:1.248~5.635)以及糖尿病病程(OR=1.064,95%CI:1.005~1.126)。结论超过半数血糖控制不达标的T2DM患者治疗过程中存在临床惰性。病程长、血糖控制差、使用两种以上口服药物以及合并糖尿病视网膜病变的患者更容易出现临床惰性。Objective To assess the clinical inertia and associated factors in type 2 diabetic(T2DM)patients with diet/exercise intervention or oral antidiabetic drugs(OADs)therapy.Methods Patients with baseline glycated hemoglobin A1c(HbA1c)≥7.0%who participated the study of"Direct Medical Cost Investigation of Diabetes in Chinese Urban Tertiary Hospitals"from March 2015 to May 2015 were recruited and their medication data of baseline and 6-month after follow-up were compared.Clinical inertia was defined as the failure to upgrade treatment after 6 months of follow-up[uninitiated with additional another OAD,glucagon-like peptide 1(GLP-1)receptor agonist or insulin].Multivariate Logistic regression was used to analyze the independent predictive factors of clinical inertia.Results A total of 178 patients[101 males and 77 females,(58±11)years,(7±7)years duration of diabetes]with the mean HbA1c(8.6±1.6)%were recruited in this study.52.2%(93/178)T2DM patients experienced clinical inertia in the 6 months following-up period.Upgraded treatment include:additional initiated with another OADs[30.9%(55/178)]or insulin[16.3%(29/178)]or GLP-1 receptor agonists[0.6%(1/178)].The main factors associated with clinical inertia were HbA1c 7.5%-8.9%(OR=3.437,95%CI:1.421-8.309)and HbA1c≥9.0%(OR=9.738,95%CI:3.634-26.901),diabetic retinopathy(OR=2.732,95%CI:1.004-7.431),taking≥2 OADs(OR=2.651,95%CI:1.248-5.635)and diabetic duration(OR=1.064,95%CI:1.005-1.126).Conclusions Clinical inertia affects more than half of T2DM patients with substandard glycemic control.Patients with longer duration of diabetes,poor glycemic control,taking≥2 OADs and complicated diabetic retinopathy are more likely to have clinical inertia.

关 键 词：糖尿病 2型 临床惰性 口服药物治疗 生活方式干预 

分 类 号：R587.1[医药卫生—内分泌]