我国社区2型糖尿病患者治疗依从性对临床产出的短期影响研究

Study on the Effects of Treatment Compliance on Short-term Clinical Outcome among Community Patients with Type 2 Diabetes Mellitus in China

目的:为提高我国社区2型糖尿病患者的治疗依从性和治疗效果提供参考。方法:利用北京大学中国卫生经济研究中心"中国糖尿病药物经济学研究"课题组的随访数据,以随访终点糖化血红蛋白(HbA1c)水平作为临床产出指标,对终点HbA1c水平进行二分类变量和数值变量的单因素分析和多元回归分析,以评价治疗依从性对短期临床产出的影响。结果:本次研究共纳入2 236例社区2型糖尿病患者,用药依从性好和差的患者分别占23.48%和76.52%;血糖监测依从性好和差的患者分别占7.02%和93.98%;饮食控制依从性好、中和差的患者分别占66.3%、23.5%和10.2%。单因素分析结果表明,血糖"控制好"组与血糖"控制差"组在患者年龄、身体质量指数、文化程度、病程、是否锻炼、饮食习惯等方面存在显著性差异(P<0.05)。多元Logistic回归和多元对数线性回归模型的分析结果相似,即患者血糖监测依从性和饮食控制依从性对终点HbA1c水平有显著的积极影响(均P<0.05),但是用药依从性的影响不显著(P>0.05)。结论:我国2型糖尿病患者的治疗依从性总体上不理想。在控制其他变量的影响之后,患者治疗依从性对终点HbA1c水平有积极的影响,尤其是血糖监测依从性和饮食控制依从性的改善将有利于血糖控制,而用药依从性的影响则不明显。

OBJECTIVE:To provide reference for improving the treatment compliance and therapeutic effect of patients with type 2 diabetes mellitus(T2DM) in China. METHODS:The follow-up data was from the issue of Pharmacoeconomic Study of Diabetic Drugs in China,which was conducted by China Center for Health Economic Research(CCHER) of Peking University.Using follow-up endpoint HbA1c level as clinical output indicator,univariate analysis and multivariable regression analysis of binary and numerical variables were performed to evaluate the effect of treatment compliance on short-term clinical outcomes.RESULTS:Totally 2 236 community T2DM patients were included for the analysis. The patients with good and poor medication compliance accounted for 23.48% and 76.52%;the patients with good and poor blood glucose monitoring compliance accounted for 7.02% and 93.98%;66.3%,23.5% and 10.2% of the patients had good,medium and poor diet control compliance,respectively. Univariate analysis showed that there was a significant difference in the "good control" group of blood glucose and the "poor control" group of blood glucose in terms of patient age,body mass index,education level,duration of disease,exercise,and eating habits,etc(P<0.05). Similar results were obtained in the analysis of multiple Logistic regression and multivariate loglinear regression models,that is,blood glucose monitoring compliance and diet control compliance had significant positive effects on end-point HbA1c(P<0.05),but drug compliance had no significant effect(P>0.05). CONCLUSIONS:The treatment compliance among community patients with T2DM in China was generally poor. After controlling for other variables,patients’ treatment compliance has a positive effect on end-point HbA1c,especially better blood glucose monitoring compliance and diet control compliance contribute to blood glucose control,but medication compliance has no significantly effect.