Investigate The Medication Patterns Of Oral Hypoglycemic Agents And Influencing Factors In Type 2 Diabetes

Objective: To investigate control situation of medication patterns of oral hypoglycemic drug in type 2 diabetes and the clinical factors that affect the levels of blood glucose.Methods:156 patients with type 2 diabetes mellitus using oral hypoglycemic agents in our outpatient clinics were enrolled into this study from June to December in 2010. The level of blood pressure, blood glucose and glycated hemoglobin,demographic data, the medication patterns of oral hypoglycemic agents,the adjustment of oral hypoglycemic medicine,the control situation of diet and exercise,the occurrence of hypoglycemia and so on were collected by face to face questionnaire survey. Multilevel analysis were employed to evaluate the effects of the treatment and clinical factors that affect blood glucose levels and occurrence of hypoglycemia.Results: Of the 156 patients, a total of 39.7% of included patients had relaxed family history of diabetes, and their mean age was 58.78±11.07 years,with mean disease courses of 5.01士4.71 years. Among the cohort consisted of unselected patients,40.1%,43.8% and 42.4% respectively reached normal levels of fasting plasma glucose(FPG),2h-postprandial glucose(2h-PG)and glycated hemoglobin(HbA1c). About 66% of the patients had regular HbA1c monitoring with average 7.08士1.61% during the one year. Of these,79.5%,54.5%,38.5% respectively insisted on the diet control,physical activity and self-management education regularly,in addition,19.2% of participants had depressive symptoms,30% of participants were worried about their health.21.2% of patients were treated with oral medication alone,78.9% of patients accepted over two kinds'of antidiabetic therapy. Biguanides(32.7%) ,sulfonylurea(23.9%),and TZDs(17.3%) took the first 3 places in medication frequency. Combination of hypoglycemic drugs biguanides and sulfonylurea were the most frequently used drugs,the rate of the two drugs accounted for 40.7% of the combination prescriptions. In the past year,a total of 57.1% patients had modified the oral hypoglycemic therapy, because of the poor clinical curative effect primarily, while about 10.9% of included patients changed the treatment without prescription.A total of 16.0% patients suffered from the complication of hypoglycemia. The bivariate logistic regression analysis indicated that age and kinds of antidiabetic therapy were independent risk factors of the occurrence of hypoglycemia,and Sulfonylurea was a secondary risk factor.The multivariate logistic regression analysis demonstrated that diet control,self-management education of diabetes patients,medical insurance,different disease courses,smoking,poor psychological quality and state of health were independent risk factors of blood glucose levels.Among these diabetic patients,a total of 52.6% of participants had hypertension,and their application rate of calcium-channel blockers(CCB),angiotensin converting enzyme inhibitors(ACEI),angiotensin II receptor blockers(ARB),beta-blockers and diuretic were respectively 30.9%,30.9%,23.6%,7.3%,5.7%. For the hypertension,75.6% of the patients using monotherapy received ACE inhibitor or ARB alone,and the combination CCB of ACE inhibitor took the first place in medication frequency. In addition,the antiplatelet therapy had been used in 12.2% of the patients, whose clinical application in the patients with hypertension was significantly higher than the diabetic patients without hypertension.Conclusion: (1)Nowadays the majority of patients made fully use of 2 or more drugs in combination as increasing of diabetic courses,but either alone or combined with drugs,biguanides were the most frequently used drugs.(2)Among 156 patients,40.1%,43.8% and 42.4% respectively reached normal levels of FPG ,2h-PG and GHbA1c. However,about a total of 30% patients were failing to control well the level of blood glucose,the main causes were as following:the neglect of antidiabetic treatment, poor psychological quality and not using insulin.(3)Age and kinds of antidiabetic therapy(especially sulfonylurea)were independent risk factors of the occurrence of hypoglycemia.(4)At the same time,diet control,self-management education of diabetes patients,medical insurance,different disease courses,smoking,poor psychological quality and state of health were independent risk factors of blood glucose levels.(5)compared to the general population,the patients with type 2 diabetes mellitus had a significantly higher incidence of hypertension. ACE inhibitor or ARB had been recommended for the first chose in the patients with hypertension. Clearly,the clinical application of aspirin is still low in the diabetic patients.