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首页> 外文期刊>Patient Preference and Adherence >Determinants and consequences of insulin initiation for type 2 diabetes in France: analysis of the National Health and Wellness Survey
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Determinants and consequences of insulin initiation for type 2 diabetes in France: analysis of the National Health and Wellness Survey

机译：法国2型糖尿病患者胰岛素起始的决定因素和后果：国家健康调查的分析

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Background: The aim of the study was to identify the intrinsic patient characteristics and extrinsic environmental factors predicting prescription and use and, more specifically, early initiation (up to 5 years of disease duration) of insulin for type 2 diabetes in France. A secondary objective was to evaluate the impact of insulin therapy on mental and physical quality of life and patient adherence.Methods: The data used in this study were derived from the 2008, 2010, and 2011 France National Health and Wellness Survey. This survey is an annual, cross-sectional, self-administered, Internet-based questionnaire among a nationwide representative sample of adults (aged 18 years or older). Of the total of 45,958 persons recruited in France, 1,933 respondents (deduped) were identified as diagnosed with type 2 diabetes. All unique respondents from the three waves, currently using insulin or oral bitherapy or tritherapy at the time of assessment, were included in this analysis.Results: Early (versus late) initiation of insulin therapy was 9.9 times more likely to be prescribed by an endocrinologist or diabetologist than by a primary care physician (P < 0.0001). Younger age at diagnosis and current smoking habits were significant predictors of early (versus late) insulin initiation (odds ratio [OR] 1.031, 95% confidence interval [CI] 1.005–1.059, P = 0.0196, and OR 2.537, 95% CI 1.165–5.524, P = 0.0191, respectively). Patients with a yearly income ≥€50,000 were less likely to be put on insulin early (P = 0.0399). A link between insulin prescription and complications was shown only in univariate analysis. Mental quality of life was lower in patients on early (versus late) insulin, but only in patients with diabetes-related complications. Insulin users (versus oral bitherapy or tritherapy users) had 3.0 times greater odds of being adherent than uncontrolled oral bitherapy or tritherapy users (OR 2.983, 95% CI 1.37–6.495, P = 0.0059).Conclusion: This study confirms the role of specialists in early initiation of insulin, and the data presented herein reflect the fact that early initiation is more frequent in younger patients, patients with diabetes-related complications, and current smokers, and less frequent in patients with a higher income. Moreover, we observed that being treated with insulin was not associated with deterioration in quality of life, and insulin-treated patients were more often adherent than uncontrolled oral bitherapy or tritherapy users. These data suggest that doctors' concerns about patient adherence and detrimental effects on quality of life should not be a barrier to their decision regarding early initiation of insulin therapy. Due to the nature of this cross-sectional survey (eg, inability to assess treatment flow), further research is needed to confirm its findings.
机译：背景：该研究的目的是确定患者的内在特征和外在环境因素，这些因素可预测处方和使用，尤其是法国的2型糖尿病的胰岛素的早期开始（疾病持续时间长达5年）。次要目标是评估胰岛素治疗对心理和身体生活质量以及患者依从性的影响。方法：本研究中使用的数据来自2008年，2010年和2011年法国国家健康状况调查。这项调查是一项基于互联网的年度，横断面，自行管理的问卷，涉及全国范围内代表性的成年人（18岁以上）。在法国招募的45,958名人员中，有1,933名受访者（已淘汰）被确定患有2型糖尿病。分析中包括了目前在使用胰岛素，口服联用疗法或三联疗法的三个浪潮中所有独特的应答者。结果：内分泌科医师开具的早期（相对于晚期）开始胰岛素治疗的可能性高9.9倍或糖尿病医生比初级保健医生高（P <0.0001）。诊断时年龄较小和当前吸烟习惯是早期（相对于晚期）开始胰岛素的重要预测因素（赔率[OR] 1.031，95％置信区间[CI] 1.005-1.059，P = 0.0196，OR 2.537，95％CI 1.165） –5.524，P = 0.0191）。年收入≥50,000欧元的患者早期服用胰岛素的可能性较小（P = 0.0399）。胰岛素处方与并发症之间的联系仅在单变量分析中显示。早期（相对于晚期）胰岛素患者的心理生活质量较低，但仅在糖尿病相关并发症患者中。胰岛素使用者（与口服双重疗法或三联疗法使用者相比）的服药几率是不受控制的口服双重疗法或三联疗法使用者的3.0倍（OR 2.983，95％CI 1.37–6.495，P = 0.0059）。结论：本研究证实了专家的作用胰岛素的早期启动，并且本文提供的数据反映了以下事实：年轻患者，患有糖尿病相关并发症的患者和目前吸烟的人群中，早期启动的频率较高，而收入较高的患者的早期启动频率较低。此外，我们观察到，接受胰岛素治疗与生活质量下降无关，与接受胰岛素治疗的患者相比，未经控制的口服联合疗法或三联疗法使用者更易坚持治疗。这些数据表明，医生对患者依从性和对生活质量的不利影响的担忧不应成为他们就尽早开始胰岛素治疗的决定的障碍。由于这种横断面调查的性质（例如，无法评估治疗流程），需要进一步的研究来确认其发现。

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