剂量优化基础胰岛素治疗达标的关键因素.ppt

GAPP调查研究结果显示，87%的医生认为胰岛素治疗患者的血糖控制不佳，约80%的医生表示因为有低血糖的顾虑，因此他们不能积极的调整胰岛素剂量。 Aims: To examine patient and physician beliefs regarding insulin therapy and the degree to which patients adhere to their insulin regimens. Methods: Internet survey of 1250 physicians (600 specialists, 650 primary care physicians) who treat patients with diabetes and telephone survey of 1530 insulin-treated patients (180 with Type 1 diabetes, 1350 with Type 2 diabetes) in China, France, Japan, Germany, Spain, Turkey, the UK or the USA. Results: One third (33.2%) of patients reported insulin omission ? non-adherence at least 1 day in the last month, with an average of 3.3 days. Three quarters (72.5%) of physicians report that their typical patient does not take their insulin as prescribed, with a mean of 4.3 days per month of basal insulin omission ? non-adherence and 5.7 days per month of prandial insulin omission ? non-adherence. Patients and providers indicated the same five most common reasons for insulin omission ? non-adherence: too busy; travelling; skipped meals; stress ? emotional problems; public embarrassment. Physicians reported low patient success at initiating insulin in a timely fashion and adjusting insulin doses. Most physicians report that many insulin-treated patients do not have adequate glucose control (87.6%) and that they would treat more aggressively if not for concern about hypoglycaemia (75.5%). Although a majority of patients (and physicians) regard insulin treatment as restrictive, more patients see insulin treatment as having positive than negative impacts on their lives. Conclusions: Glucose control is inadequate among insulin-treated patients, in part attributable to insulin omission ? nonadherence and lack of dose adjustment. There is a need for insulin regimens that are less restrictive and burdensome with lower risk of hypoglycaemia. * 患者担心低血糖而故意减少基础胰岛素剂量 * 体重增加是患者起始和优化胰岛素的主要障碍 Fear of weight gain, on the part of the both patient and the physician, is a top barr