| Objective:To find there are regional differences of antidiabetic medication and their effects on metabolic control using data from a nationwide epidemiological study in 2013.Methods:From January to July,2013,the nationwide project "glycated hemoglobin monitoring network" led by China Diabetes society retrieved epidemiological data from patients with type 2 diabetes mellitys in 549 hospitals in 80 cities in 29 provinces and cities.A standardized questionnaire collected in the form of age ≥ 18 years old,which receiving insulin,insulin combined oral hypoglycemic agents in patients with basic information,clinical examination,laboratory test data.All data were used SPSS 22 software for statistical analysis,medication differences between regions using chi-square test,the two samples were t-test between the mean.Result:1.The general characteristics of retrieved patients.A total of 228,639 cases were collected nationwide,with 113,817 patients using insulin(49.7%).The percentage of men with insulin was higher in those with insulin(54.3% vs 55.2%,F = 19.55,P <0.001),older(57.53 ± 11.36 vs 58.57 ± 11.89 years,t =-21.529),HbA1c(4.67 ± 4.33 vs 6.50 ± 5.86 years,t =-85.100,P <0.001),BMI was greater(24.01 ± 3.10 vs 24.37 ± 3.05,t = 21.393,(P <0.001),fasting blood glucose(8.05 ± 2.27 vs 8.42 ± 2.47,t =-37.560,P <0.001)and postprandial blood glucose(11.22 ± 3.47 vs 11.85 ± 3.70,t =-41.866,P <0.001).Blood pressure,total cholesterol,triglyceride and LDL-c were lower.Combination of Oral antidiabetic agents with insulin did not increase the rate of A1 C targeted less than 7%(28.8% vs 18.8%)and the patients were relatively older(57.27 vs 59.87)with longer duration(6.05 vs 6.95)compared with those with insulin only.When the insulin regimens were grouped into premeal short insulin only(fast acting insulin analogue / regular recombinant human insulin),basal insulin only(NPH / long acting insulin analogues),premixed insulin(premix 30 or 50),basal-bolus insulin(premeal short insulin+ basal NPH or long-acting insulin analogues),it was found premixed insulin was the major insulin regimen used(71.3%).A1 C target reaching was lowest in patients with basal-bolus insulin(18.1%).Patients with other regimens reached a target rate of 21.7%-24.8%.For types insulin selected,it was found insulin analogues were mostly used in comparison with recombinant human insulin(66.2% vs 33.8%).2.Regional differences of antidiabetic medications and their effects on glycemic control in different areas of China.Data were grouped into six regions: Northeast,North,Northwest,Southwest,East,and Centrosouth.Insulin use rate was highest in Northeast region(64.9%)and lowest in Centrosouth region(40.7%).A1C<7.0% target was over 30% in regions of Northwest,Southwest,East,while was the lowest(18.8%)in Northeast region.Usage of premeal insulin only regimen was lowest(5.1%)in centrosouth,and highest in Northwest region(9.1%).The usage of basal insulin only was highest level(17.3%)in northwest region,and lowest in southwest region(5.8%).Useage of basal bolus insulin was highest in northeast region(12.8%),while the lowest was in in centrosouth region(5.8%).For premix insulin the highest usage was in southwestern region(74.9%),and the lowest was in northwest region(68.9%).3.Analysis of differences in insulin regimen selection and its effect on metabolic control in northeast region,central-soutern region of ChinaInsulin usage rate was highest in northeast region,and lowest in centrosourth region,therefore,these regions was selected for further analysis.A total of 30,353 cases were in the northeast region,namely,Heilongjiang Province,Jilin Province and Liaoning Province,accounting for 20.5%,26.7% and 52.8% respectively.Patients from Liaoning Province was the oldes in age(57.33 years old),longest in diabetes duration(8.24 years),and the highest in A1 C target of less than 7%(22.4%).There were 35,040 cases in Centrosouth region,including Henan Province(10463 cases,29.8%),Guangdong Province(9559 cases,27.2%),Hainan Province(1435 cases,4.1%),Hunan Province(4248 cases,12.1 cases %),Hubei Province(9435 cases accounted for 26.8%).Patients from Hainan Province was the olderest(60.18 years),the shortest in diabetes duration(6.33 years),the lowest in targeting A1 C <7.0%(15.3%).For all insulin therapy,the insulin only therapy was higher than insulin oral combination.Oral antidiabetic agents was more selected for patients in centraosouth region than northeast region.A1C<7.0% was targeted less than 30% in both regions and their provinces and cities.4.Analysis of differencs in insulin regimens selection in specific hospital from Dalian and Shenyang of Liaoning Province of northest regionThe ratio of patients receiving insulin therapy in Shenyang City was lower than that in Dalian City(59.8% % vs 61.6%),with higher insulin only(31.5% vs 18.4%)and lower insulin oral combination rate(28.3% vs 43.2%).The most low insulin usage rate was 8.1% hospital “J”,and there was three hospital with a insulin usage rate of100% while in Dalian the most low was hospital “B”(27.9%),the highest rate was 99.7% in hospital “H”.In general higher insulin only usage had higher A1C<7.0% target.Conclusion:1.Significant differences exist in the use of antidiabetic medication in different regions of our country.2.The highest rate of insulin regimen was premix inslin,and more than half of insulin users use insulin without combination with orals.3.In general,more insulin usage did not result better A1C<7.0% target rate while some hospitals with very high proportion insulin usage did show higher A1C<7.0% target rate. |
PDF Full Text Request