南京地区各级医院降糖药物使用情况分析

Application analysis of hypoglycemic drugs in different grade hospitals in Nanjing area

目的:系统分析南京地区各级医院降糖药物使用情况,为更好地推动糖尿病分级诊疗提供参考。方法:利用用药频度(defined daily dose system,DDDs)对2016—2018年南京地区55家医院降糖药物使用情况进行统计分析。结果:磺脲类、胰岛素、二甲双胍和α糖苷酶抑制剂在南京地区降糖药物总DDDs中的构成比分别为30.51%、23.40%、18.12%和11.53%,胰高血糖素样肽-1(GLP-1)受体激动剂和钠-葡萄糖共转运蛋白-2(SGLT-2)抑制剂仅占0.44%和0.03%。三级医院中,胰岛素的DDDs构成比为24.72%,使用量最大。二级医院中,噻唑烷二酮类的DDDs构成比为4.96%,高于二肽基肽酶-4(DPP-4)抑制剂和格列奈类,位列第五。一级医院中,磺脲类的DDDs构成比高达47.92%,而DPP-4抑制剂仅占0.09%。各级医院降糖药物目录一致率呈逐年下降趋势,三级医院与二级医院的一致率最高,而一级医院与二、三级医院的一致率最低,在2018年一致率仅为66.67%。结论:南京地区各级医院在降糖药物选择和药品目录存在明显差异,需要协调一致,促进糖尿病分级诊疗。

OBJECTIVE To systematically analyze the application of hypoglycemic drugs in different grade hospitals in Nanjing area and provide reference for better promotion of hierarchical medical system.METHODS Defined daily dose system(DDDs) was used to analyze the hypoglycemic drugs in 55 hospitals in Nanjing area from 2016 to 2018.RESULTS The composition ratios of sulfonylureas, insulins, metformin and α-glucosidase inhibitors in total DDDs of hypoglycemic drugs in Nanjing area were 30.51%, 23.40%, 18.12% and 11.53%, respectively. Glucagon-like peptide-1(GLP-1) receptor agonist and sodium-glucose cotransporter-2(SGLT-2) inhibitors accounted for only 0.44% and 0.03%. In tertiary hospitals, the composition ratio of DDDs for insulin is 24.72% with the largest consumption. In secondary hospitals,the composition ratio of DDDs of thiazolidinediones was 4.96%, which was higher than that of dipeptidyl peptidase-4(DPP-4) inhibitors and glinides, ranking the fifth. In primary hospitals, the composition of DDDs of sulfonylureas was as high as 47.92%, while DPP-4 inhibitors accounted for only 0.09%. The consistency rate of the catalogues of hypoglycemic drugs in different grade hospitals had been decreasing year by year. The consistency rate between secondary hospitals and tertiary hospitals was the highest, while that between primary hospitals and secondary,tertiary hospitals was the lowest, which was only 66.67% in 2018.CONCLUSION There are significant differences in the selection of hypoglycemic drugs and drug catalogue among hospitals at all levels in Nanjing, which need to be coordinated to promote the hierarchical diagnosis and treatment of diabetes.