对非胰岛素降血糖药物的不依从性:患病率、预测因素和对血糖控制和胰岛素启动的影响。西班牙大型初级保健数据库中的一项纵向队列研究。

IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL European Journal of General Practice Pub Date : 2023-12-01 Epub Date: 2023-10-24 DOI:10.1080/13814788.2023.2268838
Rocío Zamanillo-Campos, María Zaforteza Dezcallar, Maria Asunción Boronat Moreiro, Alfonso Leiva Rus, Joana Ripoll Amengual, Jadwiga Konieczna, Maria Antonia Fiol-deRoque, Ignacio Ricci-Cabello
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引用次数: 0

摘要

背景:需要更好地了解患者对2型糖尿病药物的不依从性,以设计有效的干预措施来解决这个问题。目的:(1)估计不坚持糖尿病药物治疗的患病率;(2) 研究其对血糖控制和胰岛素启动的影响;(3) 方法:我们根据电子健康记录的数据进行了一项纵向队列研究。我们纳入了在巴利阿里群岛(西班牙)卫生服务部门注册的成年患者,他们在2016年1月至2018年12月期间开始服用新的非胰岛素降血糖药物。我们在12岁时计算出不遵守 月随访,定义为药物占有率(MPR)≤80%。我们拟合了多变量回归模型来检验不依从性与血糖控制和胰岛素启动之间的关系,并确定了不依从性的预测因素 随访数月,5740例(31.68%)无粘连。与非粘连患者相比,粘连患者的HbA1c水平较低(平均差异 = -0.32%;95%CI = -0.38%-0.27%),并且不太可能启动胰岛素(aOR=0.77;95%CI=0.63;0.94)。预测模型解释了22.3%的变异,并呈现出令人满意的表现(AUC=0.721;Brier评分=0.17)。不依从性的最重要预测因素是:非西班牙国籍,目前正在工作,对以前的药物依从性低,服用双胍类药物,吸烟者和没有高血压。结论:大约三分之一的患者不坚持服用非胰岛素降血糖药物。在考虑在常规临床实践中实施预测模型之前,需要进行更多的研究来优化预测模型的性能。
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Non-adherence to non-insulin glucose-lowering drugs: Prevalence, predictors and impact on glycemic control and insulin initiation. A longitudinal cohort study in a large primary care database in Spain.

Background: A better understanding of patient non-adherence to type 2 diabetes medication is needed to design effective interventions to address this issue.

Objectives: (1) To estimate the prevalence of non-adherence to diabetes medication; (2) to examine its impact on glycemic control and insulin initiation; (3) to develop and validate a prediction model of non-adherence.

Methods: We conducted a longitudinal cohort study based on data from electronic health records. We included adult patients registered within the Health Service of the Balearic Islands (Spain) starting a new prescription of a non-insulin glucose-lowering drug between January 2016 and December 2018. We calculated non-adherence at 12 months follow-up, defined as medication possession ratio (MPR) ≤ 80%. We fitted multivariable regression models to examine the association between non-adherence and glycemic control and insulin initiation and identified predictors of non-adherence.

Results: Of 18,119 patients identified, after 12 months follow-up, 5,740 (31.68%) were non-adherent. Compared with non-adherent, adherent patients presented lower HbA1c levels (mean difference = -0.32%; 95%CI = -0.38%; -0.27%) and were less likely to initiate insulin (aOR = 0.77; 95%CI = 0.63; 0.94). A predictive model explained 22.3% of the variation and presented a satisfactory performance (AUC = 0.721; Brier score = 0.177). The most important predictors of non-adherence were: non-Spanish nationality, currently working, low adherence to previous drugs, taking biguanides, smoker and absence of hypertension.

Conclusion: Around one-third of the patients do not adhere to their non-insulin glucose-lowering drugs. More research is needed to optimise the performance of the predicting model before considering its implementation in routine clinical practice.

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来源期刊
European Journal of General Practice
European Journal of General Practice PRIMARY HEALTH CARE-MEDICINE, GENERAL & INTERNAL
CiteScore
5.10
自引率
5.90%
发文量
31
审稿时长
>12 weeks
期刊介绍: The EJGP aims to: foster scientific research in primary care medicine (family medicine, general practice) in Europe stimulate education and debate, relevant for the development of primary care medicine in Europe. Scope The EJGP publishes original research papers, review articles and clinical case reports on all aspects of primary care medicine (family medicine, general practice), providing new knowledge on medical decision-making, healthcare delivery, medical education, and research methodology. Areas covered include primary care epidemiology, prevention, diagnosis, pharmacotherapy, non-drug interventions, multi- and comorbidity, palliative care, shared decision making, inter-professional collaboration, quality and safety, training and teaching, and quantitative and qualitative research methods.
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