The Multivariate Analysis Of The Insulin Therapy In Patients With Type 2 Diabetes

Objective:To investigate the reason why the patients with type 2 diabetes decided to accept the insulin therapy, the glucose control level before and after insulin treatment, the direct drug costs and the psychological changes of patients.Methods:390 patients with type 2 diabetes were analyzed retrospectively in the Taizhou Municipal Hospital from June to December 2010. All of them were treated with insulin for more than three months.Results:1,The reasons why patients decided to begin the insulin therapy are :the unsatisfied glucose control(61.56%), a variety of acute and chronic complications(26.46%), other medical concomitant needing the insulin therapy (7.52%).serious adverse reactions caused by oral antidiabetic drugs (3.06%), the glucose control needed for surgical operation (1.39%). Only 7.52% of the patients requested the insulin therapy, the rest patients were asked to use the insulin therapy by their doctors.2,Before treatment, the mean fasting blood glucose was 11.05±3.63 mmol/L the mean 2-hour postprandial blood glucose was 18.45±6.07mmol/L and the mean HbAlc was 9.42±2.15%. And after treatment, the mean fasting blood glucose was 7.29±1.68 mmol/L, the mean 2-hour postprandial blood glucose was 10.47±2.69mmol/L and the mean HbAlc was 7.19±1.20%. The blood glucose control was much better after the insulin treatment (P<0.01). The satisfying control of the fasting blood glucose was 2.23%. The satisfying control of the 2-hour postprandial blood glucose was 7.80%. The satisfying control of the HbAlc was 14.78%. The compliance rate of blood glucose control was significantly improved after treatment.3,The average drug cost of the 286 patients who shift from oral antidiabetic drug to insulin was 203.94 yuan per month before the insulin treatment. And the average cost was 343.10 yuan per month after the use of insulin. When comparing the two, the average monthly drug costs arose significantly after the use of insulin (P<0.01)4, Before the use of insulin,70.19% of patients worried about the insulin treatment; and there still were 40.67% of patients who worried about the insulin treatment. Before treatment, the patients'main concerns were that the use of insulin to treat the diabetes indicated their diabetes were very serious (38.72%). the fear of dependence and addiction which can not be quitted (31.20%),time-consuming and inconvenient to carry (24.79%). There was an obvious decrease in the concerns about the insulin therapy after more than three months' therapy. The patients' main concerns were time-consuming and inconvenient to carry (20.33%), the fear of dependence and addiction which can not be quitted (12.81%). the worry that the use of insulin to treat diabetes indicated their diabetes very serious (10.03%).Conclusions:1,The main reason of the type 2 diabetes patients to select insulin therapy was the poor glycemic control. The decision of beginning the insulin therapy was made by the doctor's proposal.2,The compliance rate of blood glucose control was significantly improved after the insulin treatment, so the insulin therapy is proposed as early as possible.3,The average drug costs of insulin was higher than the cost of oral antidiabetic drugs.4. The main reasons which consist the patients'psychological insulin resistance were that the use of insulin to treat the diabetes indicated their diseases were very serious, the fear of dependence and addiction which can not be quitted, time-consuming and inconvenient to carry. The psychological insulin resistance was much better after the use of insulin, so the health education should be strengthened for the diabetes.