Jianmin Wu, Fritha Morrison, Zhenxiang Zhao, Ginger Haynes, Xuanyao He, Ayad K Ali, Maria Shubina, Shervin Malmasi, Wendong Ge, Xiaomei Peng, Alexander Turchin
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In multivariable analysis adjusted for demographics and comorbidities, patients were more likely to discontinue either basal or bolus insulin if they were on a basal-bolus regimen (OR 1.6, 95% CI 1.3 to 1.8; p < 0.001) or were being seen by an endocrinologist (OR 2.6; 95% CI 2.2 to 3.0; p < 0.001).</p><p><strong>Conclusions: </strong>In this large real-world evidence study conducted in an area with a high penetration of health insurance, insulin discontinuation countenanced by healthcare providers was common. In most cases it was linked to achievement of glycemic control, achieved weight loss and initiation of other diabetes medications. 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引用次数: 5
摘要
背景:有证据表明，2型糖尿病(T2DM)患者经常停止胰岛素治疗。然而，在这一患者群体中停用胰岛素的原因和与胰岛素停用相关的因素尚不清楚。方法:我们对2010年至2017年在Partners HealthCare开具胰岛素处方的成年T2DM患者进行了一项回顾性队列研究。使用电子病历(EMR)数据研究胰岛素停药的原因和与胰岛素停药相关的因素。应用自然语言处理(NLP)从非结构化的临床记录中识别原因。从结构化电子病历数据中提取与胰岛素停药相关的因素，并使用多变量逻辑回归进行评估。结果:在7009例研究患者中，2957例(42.2%)在研究开始后12个月内停用胰岛素。大多数停止使用胰岛素的患者(2121 / 71.7%)有停药原因记录。最常见的原因是改善血糖控制(33.2%)，体重减轻(18.5%)和开始使用非胰岛素糖尿病药物(16.7%)。在针对人口统计学和合并症进行调整的多变量分析中，如果患者采用基础胰岛素方案，则更有可能停止基础胰岛素或大剂量胰岛素治疗(or 1.6, 95% CI 1.3至1.8;p结论:在医疗保险普及率高的地区进行的这项大型真实世界证据研究中，医疗服务提供者支持胰岛素停药是常见的。在大多数情况下，它与血糖控制的实现、体重的减轻和其他糖尿病药物的开始有关。与胰岛素停药相关的因素和说明的原因与先前描述的不坚持胰岛素治疗的原因不同，将其确定为一种独特的临床现象。
Reasons for discontinuing insulin and factors associated with insulin discontinuation in patients with type 2 diabetes mellitus: a real-world evidence study.
Background: Evidence suggests that insulin therapy of patients with type 2 diabetes mellitus (T2DM) is frequently discontinued. However, the reasons for discontinuing insulin and factors associated with insulin discontinuation in this patient population are not well understood.
Methods: We conducted a retrospective cohort study of adults with T2DM prescribed insulin between 2010 and 2017 at Partners HealthCare. Reasons for discontinuing insulin and factors associated with insulin discontinuation were studied using electronic medical records (EMR) data. Natural language processing (NLP) was applied to identify reasons from unstructured clinical notes. Factors associated with insulin discontinuation were extracted from structured EMR data and evaluated using multivariable logistic regression.
Results: Among 7009 study patients, 2957 (42.2%) discontinued insulin within 12 months after study entry. Most patients who discontinued insulin (2121 / 71.7%) had reasons for discontinuation documented. The most common reasons were improving blood glucose control (33.2%), achieved weight loss (18.5%) and initiation of non-insulin diabetes medications (16.7%). In multivariable analysis adjusted for demographics and comorbidities, patients were more likely to discontinue either basal or bolus insulin if they were on a basal-bolus regimen (OR 1.6, 95% CI 1.3 to 1.8; p < 0.001) or were being seen by an endocrinologist (OR 2.6; 95% CI 2.2 to 3.0; p < 0.001).
Conclusions: In this large real-world evidence study conducted in an area with a high penetration of health insurance, insulin discontinuation countenanced by healthcare providers was common. In most cases it was linked to achievement of glycemic control, achieved weight loss and initiation of other diabetes medications. Factors associated with and stated reasons for insulin discontinuation were different from those previously described for non-adherence to insulin therapy, identifying it as a distinct clinical phenomenon.
期刊介绍：
Clinical Diabetes and Endocrinology is an open access journal publishing within the field of diabetes and endocrine disease. The journal aims to provide a widely available resource for people working within the field of diabetes and endocrinology, in order to improve the care of people affected by these conditions. The audience includes, but is not limited to, physicians, researchers, nurses, nutritionists, pharmacists, podiatrists, psychologists, epidemiologists, exercise physiologists and health care researchers. Research articles include patient-based research (clinical trials, clinical studies, and others), translational research (translation of basic science to clinical practice, translation of clinical practice to policy and others), as well as epidemiology and health care research. Clinical articles include case reports, case seminars, consensus statements, clinical practice guidelines and evidence-based medicine. Only articles considered to contribute new knowledge to the field will be considered for publication.
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