使用基础胰岛素类似物治疗2型糖尿病患者低血糖发生率的研究:基于中国4家三级甲等医院的真实数据
|
摘要
目的回顾性分析中国使用基础胰岛素类似物的T2DM患者低血糖事件的发生率。方法收集2012年1月至2017年5月中国4家三级甲等医院的电子病历数据。纳入采用基础胰岛素类似物治疗的T2DM患者,包括甘精胰岛素、地特胰岛素和重组甘精胰岛素。结果共纳入4552例患者,854例(18. 8%)曾在整个研究期间内发生过低血糖事件,低血糖总体发生率为107. 99次/100患者年。非重度低血糖总体发生率为96. 28次/100患者年;重度低血糖总体发生率为11. 71次/100患者年。使用地特胰岛素的患者低血糖事件发生率相对较低。结论使用基础胰岛素类似物治疗的T2DM患者中低血糖事件的发生不容忽视,医务工作者和T2DM患者需更加重视低血糖事件的发生。
Objectives To analyze the rate of hypoglycemic events in type 2 diabetes patients using basal insulin analogues in China.Methods Retrospective electronic health record data from 4 Grade Ⅲ Class A hospitals in China from January 2012 to May 2017 was analyzed. Including criteria were patients of type 2 diabetes treated with basal insulin analogues,including insulin glargine,insulin detemir and recombinant insulin glargine.Results 4552 patients were included. 912(18. 8%)patients experienced hypoglycemia. The overall incidence of hypoglycemia was 107. 99 events/100 patient-year,of which,non-severe hypoglycemia accounted for 96. 28 events/100 patient-year and severe hypoglycemia 11. 71 events/100 patientyear. The rate of hypoglycaemia was relatively low in patients treated with insulin detemir.Conclusion Hypoglycemic events in patients treated with basal insulin analogues in China cannot be ignored. Health professionals and patients need to pay more attention on hypoglycemic events.
Objectives To analyze the rate of hypoglycemic events in type 2 diabetes patients using basal insulin analogues in China.Methods Retrospective electronic health record data from 4 Grade Ⅲ Class A hospitals in China from January 2012 to May 2017 was analyzed. Including criteria were patients of type 2 diabetes treated with basal insulin analogues,including insulin glargine,insulin detemir and recombinant insulin glargine.Results 4552 patients were included. 912(18. 8%)patients experienced hypoglycemia. The overall incidence of hypoglycemia was 107. 99 events/100 patient-year,of which,non-severe hypoglycemia accounted for 96. 28 events/100 patient-year and severe hypoglycemia 11. 71 events/100 patientyear. The rate of hypoglycaemia was relatively low in patients treated with insulin detemir.Conclusion Hypoglycemic events in patients treated with basal insulin analogues in China cannot be ignored. Health professionals and patients need to pay more attention on hypoglycemic events.
引文
[1]Frier BM.Hypoglycaemia in diabetes mellitus:epidemiology and clinical implications.Nat Rev Endocrinol,2014,10:711-722.
[2]Halimi S.Severe hypoglycaemia the“tip of the iceberg”:an underestimated risk in both type 1 and type 2 diabetic patients.Diabetes Metab,2015,41:105-106.
[3]Gold AE,MacLeod KM,Deary IJ,et al.Hypoglycemia-induced cognitive dysfunction in diabetes mellitus:effect of hypoglycemia unawareness.Physiol Behav,1995,58:501-511.
[4]Graveling AJ,Frier BM.Impaired awareness of hypoglycaemia:a review.Diabetes Metab,2010,36:S64-S74.
[5]Desouza CV,Bolli GB,Fonseca V.Hypoglycemia,diabetes,and cardiovascular events.Diabetes Care,2010,33:1389-1394.
[6]American Diabetes Association.Standards of medical care in diabetes-2015 abridged for primary care providers.Clin Diabetes,2015,33:97-111.
[7]Nathan DM,DCCT/Edic Research Group.The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years:overview.Diabetes Care,2014,37:9-16.
[8]Owens DR,Matfin G,Monnier L.Basal insulin analogues in the management of diabetes mellitus:what progress have we made?.Diabetes/Metab Res Rev,2014,30:104-119.
[9]Anderson JH,Brunelle RL,Koivisto VA,et al.Reduction of post-prandial hyperglycemia and frequency of hypoglycemia in IDDMpatients on insulin-analog treatment.Diabetes,1997,46:265-270.
[10]Davis KL,Tangirala M,Meyers JL,et al.Real-world compara-tive outcomes of US type 2 diabetes patients initiating analog bas-al insulin therapy.Curr Med Res Opin,2013,29:1083-1091.
[11]Pollock RF,Erny-Albrecht KM,Kalsekar A,et al.Long-acting insulin analogs:a review of“real-world”effectiveness in patients with type 2 diabetes.Curr Diabetes Rev,2011,7:61-74.
[12]中华医学会内分泌学分会.中国糖尿病患者低血糖管理的专家共识.中华内分泌代谢杂志,2012,28:619-623.
[13]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版).中国医学前沿杂志,2015,7:26-89.
[14]郑亚明,吴晶,谢琨.2型糖尿病患者低血糖事件发生率及费用研究.中国农村卫生事业管理,2012,32:1195-1198.
[15]马莉莉,管晓东,李晗,等.胰岛素治疗糖尿病患者低血糖发生和经济负担研究.中国药物经济学,2016,8:7-10,29.
[16]Yue X,Wu J,Ruan Z,et al.The burden of hypoglycaemia in patients with insulin-treated diabetes mellitus in China:analysis of medical record data.ISPOR,2018,4:491.
[17]李丽,祝开思.2型糖尿病基础胰岛素治疗的最新中国证据.药品评价,2015,19:13-17.
[18]Urakami T,Mine Y,Aoki M,et al.A randomized crossover study of the efficacy and safety of switching from insulin glargine to insulin degludec in children with type 1 diabetes.Endocr J,2017,64:133-140.
[2]Halimi S.Severe hypoglycaemia the“tip of the iceberg”:an underestimated risk in both type 1 and type 2 diabetic patients.Diabetes Metab,2015,41:105-106.
[3]Gold AE,MacLeod KM,Deary IJ,et al.Hypoglycemia-induced cognitive dysfunction in diabetes mellitus:effect of hypoglycemia unawareness.Physiol Behav,1995,58:501-511.
[4]Graveling AJ,Frier BM.Impaired awareness of hypoglycaemia:a review.Diabetes Metab,2010,36:S64-S74.
[5]Desouza CV,Bolli GB,Fonseca V.Hypoglycemia,diabetes,and cardiovascular events.Diabetes Care,2010,33:1389-1394.
[6]American Diabetes Association.Standards of medical care in diabetes-2015 abridged for primary care providers.Clin Diabetes,2015,33:97-111.
[7]Nathan DM,DCCT/Edic Research Group.The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years:overview.Diabetes Care,2014,37:9-16.
[8]Owens DR,Matfin G,Monnier L.Basal insulin analogues in the management of diabetes mellitus:what progress have we made?.Diabetes/Metab Res Rev,2014,30:104-119.
[9]Anderson JH,Brunelle RL,Koivisto VA,et al.Reduction of post-prandial hyperglycemia and frequency of hypoglycemia in IDDMpatients on insulin-analog treatment.Diabetes,1997,46:265-270.
[10]Davis KL,Tangirala M,Meyers JL,et al.Real-world compara-tive outcomes of US type 2 diabetes patients initiating analog bas-al insulin therapy.Curr Med Res Opin,2013,29:1083-1091.
[11]Pollock RF,Erny-Albrecht KM,Kalsekar A,et al.Long-acting insulin analogs:a review of“real-world”effectiveness in patients with type 2 diabetes.Curr Diabetes Rev,2011,7:61-74.
[12]中华医学会内分泌学分会.中国糖尿病患者低血糖管理的专家共识.中华内分泌代谢杂志,2012,28:619-623.
[13]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版).中国医学前沿杂志,2015,7:26-89.
[14]郑亚明,吴晶,谢琨.2型糖尿病患者低血糖事件发生率及费用研究.中国农村卫生事业管理,2012,32:1195-1198.
[15]马莉莉,管晓东,李晗,等.胰岛素治疗糖尿病患者低血糖发生和经济负担研究.中国药物经济学,2016,8:7-10,29.
[16]Yue X,Wu J,Ruan Z,et al.The burden of hypoglycaemia in patients with insulin-treated diabetes mellitus in China:analysis of medical record data.ISPOR,2018,4:491.
[17]李丽,祝开思.2型糖尿病基础胰岛素治疗的最新中国证据.药品评价,2015,19:13-17.
[18]Urakami T,Mine Y,Aoki M,et al.A randomized crossover study of the efficacy and safety of switching from insulin glargine to insulin degludec in children with type 1 diabetes.Endocr J,2017,64:133-140.