糖尿病患者居家应用胰岛素情况的调查分析

Investigation and analysis of insulin application at home in patients with diabetes mellitus

目的了解糖尿病患者居家应用胰岛素的现状和存在的问题。方法组织全国多家医院药师以问卷方式对门诊和住院糖尿病患者居家使用胰岛素的情况进行调查,了解胰岛素的应用情况、胰岛素注射行为、胰岛素治疗的依从性、血糖监测的依从性、胰岛素保存行为等情况,以及血糖控制达标率和低血糖等不良反应的发生情况。问卷共包含50个问题,对其中与胰岛素应用规范相关的21个问题计算其正确率,考察患者胰岛素应用行为对胰岛素治疗有效性和安全性的影响。结果共有31家医院的临床药师参与了问卷发放与调查,回收有效问卷240份。240例患者中男性106例(44.2%),女性134例(55.8%);年龄(58±15)岁;2型糖尿病210例(87.5%),1型糖尿病25例(10.4%),其他类型糖尿病5例(2.1%);使用1种胰岛素治疗者151例(62.9%),2种胰岛素治疗者89例(37.1%),涉及胰岛素13个品种。97.9%(235/240)的患者存在至少1项胰岛素应用行为的错误或者不规范,75.0%(180/240)存在至少1个胰岛素用药依从性问题,70.4%(169/240)存在血糖监测依从性差问题,68.8%(165/240)存在至少1种胰岛素保存不规范的行为。血糖控制达标率仅13.8%(33/240),低血糖发生率为55.8%(134/240)。血糖控制达标组患者胰岛素应用行为答题的总正确率与治疗依从性答题的正确率明显高于血糖控制未达标组[71.4%(57.1%,81.0%)比61.9%(52.4%,71.4%),P=0.045;77.8%(55.6%,88.9%)比66.7%(55.6%,77.8%),P=0.023],无低血糖组患者与低血糖组患者比较胰岛素应用行为及各项行为答题的正确率均无显著差异(均P>0.05)。结论胰岛素种类繁多,药名相似,极易混淆,从而导致用药错误。患者胰岛素注射行为、治疗依从性和胰岛素保存行为不规范的发生率较高,可能影响血糖控制达标率。

Objective To understand the status quo and problems of insulin application at home in patients with diabetes mellitus.Methods Pharmacists in many hospitals across the country were orga⁃nized to conduct a questionnaire survey on status quo of insulin application in patients with diabetic mellitus,so as to understand their insulin use,insulin injection behavior,insulin treatment adherence,glucose moni⁃toring adherence,insulin preservation behavior,rate of up to target blood glucose,and the incidence of adverse reactions such as hypoglycemia.The questionnaire contained 50 questions,the accuracy rate of 21 questions related to insulin application norms was calculated,and the effect of insulin application behavior of patients on the efficacy and safety of insulin therapy was investigated.Results Clinical pharmacists from 31 hospitals across the country participated in the questionnaire distribution and survey,and 240 valid questionnaires were returned.Among the 240 patients,106(44.2%)were male and 134(55.8%)were fe⁃male,aged(58±15)years;210(87.5%)had type 2 diabetes mellitus,25(10.4%)had type 1 diabetes melli⁃tus,and 5(2.1%)had other types;151(62.9%)patients were treated with one kind of insulin,89(37.1%)were treated with 2 kinds of insulin,and a total of 13 kinds of insulin were involved;97.9%(235/240)of the patients had at least one wrong or irregular insulin use behavior,75.0%(180/240)had at least one prob⁃lem related to insulin treatment adherence,70.4%(169/240)had poor glucose monitoring adherence,and 68.8%(165/240)had at least one irregular insulin preservation behavior.The rate of up to target blood glu⁃cose was only 13.8%(33/240),and the incidence of hypoglycemia was 55.8%(134/240).The total correct rates of answers to insulin use behavior and treatment adherence in patients with up to target blood glucose were significantly higher than those in patients without up to target blood glucose[71.4%(57.1%,81.0%)vs.61.9%(52.4%,71.4%),P=0.045;77.8%(55.6%,88.9%)vs.66.7%(55.6%,77.8%),P=0.023],and differ⁃ences in the correct rate of answers to insulin use behavior and each behavior between the patients with and without hypoglycemia were not statistically significant(all P>0.05).Conclusions Insulin has a wide variety and similar drug names,which are easily confused,leading to medication errors.The incidence of irregular insulin injection behavior,treatment adherence,and insulin preservation behavior in patients is high,which may affect the rate of up to target blood glucose.