成人2型糖尿病胰岛素处方特点及其与血糖控制的关系

IF 1.4 Q4 ENDOCRINOLOGY & METABOLISM

Diabetes epidemiology and management Pub Date : 2025-07-01 DOI:10.1016/j.deman.2025.100260

Helen Chen , Lappui Chung , Michael Weiner , Mark Fu , Patrick Balius , Julian Wolfson

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引用次数: 0

摘要

目的探讨胰岛素处方特征与血糖控制的关系。方法使用电子健康记录（2017-2023）来识别美国中西部地区在血红蛋白A1c （HbA1c）结果当天门诊就诊的2型糖尿病成人处方胰岛素。胰岛素处方特征包括每日总剂量、提供最大剂量和指示类型（给药频率、碳水化合物计数、校正和滑动刻度）。混合效应线性和逻辑回归模拟了HbA1c和满足HbA1c目标（18 - 64岁为<；7，≥65岁为<；8）。结果11179例患者，平均年龄53岁；其中男性占49%，白人占58%。总体队列血糖控制较低，中位HbA1c为9.3；糖化血红蛋白达标的16%；末次随访时平均HbA1c为8.7%。指导类型为88%给药频率，7%校正，3%滑动刻度，1%碳水化合物计数。HbA1c降低与碳水化合物计数（- 0.4,p = 0.009）、校正(- 0.2,p <；0.001)，滑动刻度（- 0.1,p = 0.014），以及提供最大每日胰岛素剂量(- 0.02,p <；0.001)。每日总胰岛素剂量增加10个单位与HbA1c增加0.001相关（p = 0.003）。纠正指导达到HbA1c目标的可能性是给药频率的1.4倍(p <；0.001)。结论胰岛素指导类型与血糖控制相关，但血糖控制水平较低。

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Characteristics of insulin prescriptions and their association with glycemic control in adults with type 2 diabetes mellitus

Objective

We assessed the association between insulin prescription characteristics and glycemic control.

Methods

Electronic health records (2017–2023) were used to identify adults with type 2 diabetes prescribed insulin from outpatient visits on the same day as a hemoglobin A1c (HbA1c) result in a Midwest US region. Insulin prescription characteristics were total daily dose, providing a maximum dose, and instruction types (dosing frequency, carbohydrate (carb) counting, correction, and sliding scale). Mixed-effects linear and logistic regression modeled HbA1c and meeting HbA1c target (<7 for age18–64 and <8 for age

\geq

65).

Results

Among 11,179 subjects, mean age was 53; 49 % were male, and 58 % White. Overall cohort glycemic control was low, median HbA1c was 9.3; 16 % met HbA1c target; mean HbA1c at last follow-up was 8.7 %. Instruction types were 88 % dosing frequency, 7 % correction, 3 % sliding scale, and 1 % carb counting. HbA1c reduction was associated with carb counting (−0.4, p = 0.009), correction (−0.2, p < 0.001), sliding scale (−0.1, p = 0.014), and providing a maximum daily insulin dose (−0.02, p < 0.001). An increase in total daily insulin dose by 10 units was associated with a 0.001 increase in HbA1c (p = 0.003). Correction instruction was 1.4 times more likely than dosing frequency to meet HbA1c target (p < 0.001).