The Pharmacoepidemiological Study Of Antidiabetic Drugs In Elderly Diabetes Mellitus In Shanghai

Diabetes mellitus (DM) and its chronic complications has been the third dead cause following cancer and cardiovascular diseases. Many clinical data show the common actions resulting from bad control of plasma glucose and pathological changes relative to aging further accelerate the onset of diabetic complications. So it is important to choose antidiabetic drugs and strengthen the treatment for elderly DM.The aims of our studies are as follows. ⑴ To probe methods of drugs monitor in crowd and build pharmacoepidemiological intelligent data system, in order to provide experiences and instrument for pharmacoepidemiological study in our country. ⑵ To know the utilization and influence factors of antidiabetic drugs in elderly DM. ⑶ To do multiple evaluation to effect and economy of antidiabetic drugs.To realize the aims above, we first develop the pharmacoepidemiological study of antidiabetic drugs in elderly DM in Shanghai. The contents are as follows.PartⅠ:Dynamic analysis of 5-year utilization of OHA in ShanghaiUsing DDD in the study of drug utilization. During 5a, DDDs and costs of oral hypoglycemic agents (OHA) had increased rapidly; Of them, gliclazide is dominant, the DDDs of metformin increased rapidly, the DDDs and costs of acarbose is inconsistent, show that there lies questions of high cost and limited drug resource.PartⅡ:Analysis of adverse drug reaction of antidiabetic agents according to documents within forty-two years in ChinaA metrological analysis was conducted to explore the general law and characte- ristic of ADR of antidiabetic agents. Results: The amounts of ADR were equal in men and women, and mainly aged from 45 to 74. The major ADRs were metabolism and nutrition barriers, nervous system injured, mental disorder and gastrointestinal system injured. Except acarbose causing stomach and intestinal system injured, the rest ADR was mainly caused by sulfonylureas (SUs). The most of outcomes of ADR were good, but also quite a number of them left sequela or dieing. Conclusion: The ADR of antidiabetic agents were comprehensive, some of them were serious. It is worth attaching clinical importance to.Part Ⅲ:The drug utinization study of antidiabetic drugs in elderly inpatientsWe first analyzed the antidiabetic drug treatment pattern and evaluated its curative effect, meanwhile we used the cost-effectiveness analysis (CEA) method to synthet- ically evaluate the different regimens. Results:⑴ The most commonly used antidia- betic drugs in elderly inpatients was acarbose(70.7%), the following were insulin (56.6%) and gliclazide(49.0%).⑵ With the increase of course, inpatients respectively with therapy of OHA or insulin significantly decreased and increased, but the overall ratio of insulin was low. The inpatients with good and general control of admission HbA1c mostly took OHA, while those with bad HbA1c control mostly took insulin. The chief aim of insulin therapy was to control hyperglycemia. To curative effect, insulin was significantly good to OHA.⑶ The CEA showed gliclazide+metformin and gliclazide+acarbose+insulin were better regimen respectively in the treatment pattern of OHA and insulin. Conclusion: In order to obtain better therapeutic effect, we suggested the elderly diabetic patients with poor plasma glucose control by OHA take insulin timely; the method of pharmacoeconomics is valuable to instruct rational medication in clinic, through evaluation from both cost and curative effectiveness.Part Ⅳ:The antidiabetic drugs monitor in elderly population in ShanghaiWe investigated the drug utilization of antidiabetic drugs and analyzed influence factors in Logistic regression and Pearson correlation models. In evaluating quality of life (QOL) of elderly DM, we first used SF-36 scale. Results and conclusions:⑴ We first built a drug monitor system in elderly DM population, it adopted to study of pharmaco- epidemiology.⑵The percentage of not taking medicine, taking medicine irregularly and regularly respectively were 6.48%,60.39% and 33.13%; glycemic controll...