华北地区15家三甲医院门诊血糖控制不佳患者的用药情况分析

Application analysis of hypoglycemic drugs in out-patients with unsatisfactory blood glucose control in 15 hospitals in north China

目的:对华北地区血糖控制不佳的糖尿病患者用药情况进行调查,为降糖药物的合理使用提供参考。方法:通过门诊访谈、调查问卷、查体、实验室检查和回顾病历的方式,收集2006年12月-2007年3月华北地区15家三甲医院门诊血糖控制不佳糖尿病患者的信息,包括一般情况、血糖控制情况、治疗用药和就诊前3个月低血糖发生情况。结果:糖尿病患者应用最多的药物为双胍类(40.4%),其次为磺脲类(38.9%)。应用磺脲类药物达最大剂量和超剂量的患者最多(24.0%),发生低血糖的患者较多(占所有低血糖患者的61.9%)。单纯生活方式干预和单药治疗的患者所占比例大,联合用药的患者仅占24.1%。单药治疗的病程为(3.7±3.2)年。回归分析显示,用药种类与药物的应用剂量和病程呈正相关,与餐后血糖(PBS)呈负相关。结论:华北地区血糖控制不佳的患者,部分药物应用剂量偏大,增加了低血糖发生的风险;单纯生活方式控制和单药治疗所占比例过大,开始用药治疗和联合用药的时间过晚;存在部分不合理联合用药情况。建议早期规范联合用药,减少单药剂量。

Objective：To analyze the application of hypoglycemic drugs in out-patients with unsatisfactory blood glucose control in north China to provide reference to rational use of antidiabetic drugs.Methods：The information of out-patients whose blood glucose control were not ideal,including general conditions,blood glucose level,the use of hypoglycemic drugs and hypoglycemia event happened in recent 3 months,were collected through clinic interviews,questionnaires,physical examinations,laboratory tests and past history review,in 15 hospitals in north China from December 2006 to March 2007.Results：Metformin was the most frequently used medicine（40.4%）,followed by sulfonylurea（38.9%）.The dose of sulfonylurea was relatively higher with 24% patients using maximum-dose or over-dose,which contributed to the major cause of hypoglycemia（61.9% of the total hypoglycemia）.Most patients accepted lifestyle intervention or received only one kind of drugs to control blood glucose,the proportion of the patients with combined medication was only 24.1%.The duration using one kind of drugs was（3.7±3.2） years.The kinds of drugs used in the patients had positive correlation with dose and duration,and negative correlation with postprandial blood sugar（PBS）.Conclusion：The dosages of some drugs were too high,which increased the risk of hypoglycemia.Too many patients used lifestyle intervention or only one kind of drugs for controlling blood glucose,and the initial time of medicine treatment and combined medication were too late.Furthermore,there were some unreasonable problems in combination therapy.It is suggested that drug combination should be executed earlier and more rationally,so that the dose could be controlled strictly in limits.