|
Pharmacy Information 2024
基于真实医疗大数据的2型糖尿病患者药物利用分析和疗效分析
|
Abstract:
目的:借助现实医疗大数据平台进行重庆市2型糖尿病患者的流行特征和药物利用情况分析;比较迟发性患者和早发性患者在药物利用和疗效的差异并分析其影响因素,为重庆市2型糖尿病患者临床用药提供参考。方法:选取“医渡云”医疗大数据平台2019年1月1日至2021年12月31日的2型糖尿病患者病历数据,使用卡方检验比较早发性患者和迟发性患者的流行特征、用药和疗效情况;使用非条件logistic回归分析患者疗效的影响因素,检验水准取α = 0.05。结果:早发性患者和迟发性患者在年龄、性别、病程、和合并症方面的差异有统计学意义。降血糖药物使用频率由高到低排名为:胰岛素、二甲双胍、α-葡萄糖苷酶抑制剂、钠–葡萄糖转运蛋白2抑制剂和磺脲类药物。早发性患者和迟发性患者用药结构的差异存在统计学差异,早发性患者更倾向于胰岛素相关的药物使用方案,而迟发性患者倾向于口服降血糖药物的药物治疗方案。重庆市2型糖尿病患者血糖控制达标率为53.4%,迟发性2型糖尿病患者血糖控制达标患者为53.5%,早发性2型糖尿病患者血糖控制达标患者为53.4。患者疗效的因素包括:病程、年龄、吸烟史、饮酒史、是否使用联合用药、糖化血红蛋白水平和合并症数量。早发性患者的疗效受病程、吸烟史、饮酒史、糖化血红蛋白影响,而迟发性患者的疗效受病程、饮酒史、合并症和是否联合用药影响。结论:重庆市2型糖尿病应关注早发性患者和迟发性患者用药结构的差异,临床上应重视病程长、具有吸烟饮酒史、糖化血红蛋白异常和具有合并症的患者,采取合理的联合用药方案来有效地控制血糖,提高患者的疗效。
Objective: This study aims to analyze the characteristics and drug utilization of patients with type 2 diabetes in Chongqing using a real-world medical big data platform. It also aims to compare the differences in drug utilization and efficacy between late-onset patients and young-onset patients and to analyze their influencing factors, providing reference for clinical medication in patients with type 2 diabetes. Methods: The medical records of type 2 diabetes patients on the “Yidu Cloud” medical big data platform from January 1, 2019, to December 31, 2021, were selected. The characteristics, medication patterns, and efficacy were compared between young-onset patients and late-onset patients using the chi-square test. The influencing factors of patient efficacy were analyzed using unconditional logistic regression, with a significance level set at α = 0.05. Results: Statistically significant differences were observed between early-onset patients and late-onset patients in terms of age, gender, disease duration, and comorbidities. The frequency of hypoglycemic drug use, in descending order, was: insulin, metformin, α-glucosidase inhibitors, sodium-glucose transporter 2 inhibitors, and sulfonylureas. There was a significant difference in medication patterns between early-onset patients and late-onset patients, with young-onset patients more likely to use insulin-related regimens and late-onset patients more likely to use oral hypoglycemic drugs. The blood glucose control rate among type 2 diabetes patients in Chongqing city is 53.4%, and the rate of blood glucose control in late-onset patients is 53.5%, while the rate of blood glucose control in young-onset patients is 53.4%. Factors influencing patients’ outcomes included disease duration, age, smoking history, drinking history, concomitant medication use, glycosylated hemoglobin levels, and the number of
[1] | 陈迁. 糖尿病医疗数据处理及药物利用研究[D]: [博士学位论文]. 上海: 第二军医大学, 2015. |
[2] | 杨益. 2型糖尿病药物治疗方案预测的方法研究[D]: [博士学位论文]. 北京: 北京协和医学院, 2021. |
[3] | Luo, Z., Fabre, G. and Rodwin, V.G. (2020) Meeting the Challenge of Diabetes in China. International Journal of Health Policy and Management, 9, 47-52. https://doi.org/10.15171/ijhpm.2019.80 |
[4] | Buysschaert, M., Medina, J., Buysschaert, B., et al. (2016) Definitions (and Current Controversies) of Diabetes and Prediabetes. Current Diabetes Reviews, 12, 8-13. https://doi.org/10.2174/1573399811666150122150233 |
[5] | Donnan, K. and Segar, L. (2019) SGLT2 Inhibitors and Metformin: Dual Antihyperglycemic Therapy and the Risk of Metaboacidosis in Type 2 Diabetes. European Journal of Pharmacology, 846, 23-29. https://doi.org/10.1016/j.ejphar.2019.01.002 |
[6] | Badaru, A., Klingensmith, G.J., Dabelea, D., et al. (2014) Correlates of Treatment Patterns among Youth with Type 2 Diabetes. Diabetes Care, 37, 64-72. https://doi.org/10.2337/dc13-1124 |
[7] | Chan, J., So, W., Ko, G., et al. (2009) The Joint Asia Diabetes Evaluation (JADE) Program: A Web-Based Program to Translate Evidence to Clinical Practice in Type 2 Diabetes. Diabetic Medicine, 26, 693-699. https://doi.org/10.1111/j.1464-5491.2009.02751.x |
[8] | 中国2型糖尿病防治指南(2020年版) [J]. 中国实用内科杂志, 2021, 41(8): 668-695. https://doi.org/10.19538/j.nk20210106 |
[9] | 丁贤彬, 毛德强, 焦艳, 等. 重庆市糖尿病患病率、死亡率及伤残调整寿命年率分析[J]. 上海交通大学学报(医学版), 21, 41(1): 78-81. |
[10] | 章小敏, 陈将, 陈翔, 等. 分级诊疗与不同级别医院间药品使用研究[J]. 医院管理论坛, 2019, 36(9): 20-23 37. |
[11] | 杨燕, 吴文辉, 汤庆伟, 等. 基于药品采购数据库的上海市各级医疗机构降糖药物利用情况分析[J]. 中国卫生经济, 20, 36(3): 53-56. |
[12] | 马纪林, 张雪平. 基于医院信息管理系统的上海市松江区糖尿病患者药物使用情况研究[J]. 中国全科医学, 2020, 23(31): 4000-4006. |
[13] | 林美玲, 付金华, 黄晓莉. 糖尿病住院患者合理用药分析[J]. 海峡药学, 2017, 29(7): 238-240. |
[14] | 王知力, 覃思蓓, 曹伟灵, 等. 深圳市公立医疗机构2019年度糖尿病治疗用药分析[J]. 海峡药学, 2022, 34(2): 113-117. |
[15] | 胡葵茹, 王宇彤, 石钰霖, 等. 中国人群吸烟所致疾病风险的Meta分析[J]. 中国预防医学杂志, 2021, 22(4): 250-256. https://doi.org/10.16506/j.1009-6639.2021.04.003 |
[16] | 叶青, 秦真真, 陈一佳, 等. 饮酒和体力活动对社区2型糖尿病患者血糖控制的影响[J]. 东南大学学报(医学版), 2023(1): 46-51. |
[17] | Lee, C.W., Wu, S.H., Chiu, W.C., et al. (2021) The Medications and Health Care Utilization of Patients Newly Diagnosed with Type 2 Diabetes Mellitus: A Nationwide Population-Based Cohort Study. Journal of the Formosan Medical Association, 120, 130-136. https://doi.org/10.1016/j.jfma.2020.03.001 |
[18] | Yang, Y.S., Han, K., Sohn, T.S., et al. (2021) Young-Onset Type 2 Diabetes in South Korea: A Review of the Current Status and Unmet Need. The Korean Journal of Internal Medicine, 36, 1049-1058. https://doi.org/10.3904/kjim.2021.379 |
[19] | Basu, S., Yudkin, J.S., Kehlenbrink, S., et al. (2019) Estimation of Global Insulin Use for Type 2 Diabetes, 2018-30: A Microsimulation Analysis. The Lancet Diabetes & Endocrinology, 7, 25-33. https://doi.org/10.1016/S2213-8587(18)30303-6 |
[20] | Kaneto, H., Takami, A., Spranger, R., et al. (2020) Efficacy and Safety of Insulin Glargine/Lixisenatide Fixed-Ratio Combination (iGlarLixi) in Japanese Patients with Type 2 Diabetes Mellitus Inadequately Controlled on Basal Insulin and Oral Antidiabetic Drugs: The LixiLan JP-L Randomized Clinical Trial. Diabetes, Obesity and Metabolism, 22, 3-13. https://doi.org/10.1111/dom.14005 |
[21] | Tseng, Y.J., Steinberg, G., Fox, K.P., et al. (2017) Antihyperglycemic Medications: A Claims-Based Estimate of First-Line Therapy Use Prior to Initialization of Second-Line Medications. Diabetes Care, 40, 1500-1505. https://doi.org/10.2337/dc17-0213 |
[22] | Oishi, M., Yamazaki, K., Okuguchi, F., et al. (2014) Changes in Oral Antidiabetic Prescriptions and Improved Glycemic Control during the Years 2002-2011 in Japan (JDDM32). Journal of Diabetes Investigation, 5, 581-587. https://doi.org/10.1111/jdi.12183 |
[23] | Shin, H., Schneeweiss, S., Glynn, R.J., et al. (2021) Trends in First-Line Glucose-Lowering Drug Use in Adults with Type 2 Diabetes in Light of Emerging Evidence for SGLT-2i and GLP-1RA. Diabetes Care, 44, 1774-1778. https://doi.org/10.2337/dc20-2926 |
[24] | Thi Bui, D.H., Nguyen, B.X., Truong, D.C., et al. (2021) Polypharmacy among People Living with Type 2 Diabetes Mellitus in Rural Communes in Vietnam. PLOS ONE, 16, e0249849. https://doi.org/10.1371/journal.pone.0249849 |
[25] | Van Oort, S., Rutters, F., Warle-Van Herwaarden, M.F., et al. (2021) Characteristics Associated with Polypharmacy in People with Type 2 Diabetes: The Dutch Diabetes Pearl Cohort. Diabetic Medicine, 38, e14406. https://doi.org/10.1111/dme.14406 |
[26] | 朱小莹, 任碧琦, 苏欣月, 等. 西安市药店慢病管理的2型糖尿病患者用药和血糖控制情况分析[J]. 药物流行病学杂志, 2024, 33(2): 184-193. |
[27] | 周小琦, 李芳, 刘新会, 等. 不同性别老年糖尿病患者血糖控制情况及影响因素分析[J]. 公共卫生与预防医学, 2022, 33(6): 80-85. |
[28] | Li, J., Chattopadhyay, K., Xu, M., et al. (2019) Prevalence and Predictors of Polypharmacy Prescription among Type 2 Diabetes Patients at a Tertiary Care Department in Ningbo, China: A Retrospective Database Study. PLOS ONE, 14, e0220047. https://doi.org/10.1371/journal.pone.0220047 |
[29] | 张秋伊, 盛红艳, 顾淑君. 饮酒与2型糖尿病患者血糖控制之间的关系[J]. 中国慢性病预防与控制, 2017, 25(12): 905-907. https://doi.org/10.16386/j.cjpccd.issn.1004-6194.2017.12.007 |
[30] | 季红运, 蒙连新, 吴娜等. 百色市老年糖尿病患者慢性并发症的患病现状及血糖控制情况分析[J]. 糖尿病新世界, 2022, 25(12): 190-194 198. https://doi.org/10.16658/j.cnki.1672-4062.2022.12.190 |
[31] | Luk, A.O.Y., Kong, A.P.S. and Basu, A. (2020) Young-Onset Diabetes, Nutritional Therapy and Novel Insulin Delivery Systems: A Report from the 21st Hong Kong Diabetes and Cardiovascular Risk Factors—East Meets West Symposium. Diabetic Medicine, 37, 1234-1243. https://doi.org/10.1111/dme.14335 |