Background: Because there has been no quality improvement initiatives targeting patients with type 2 diabetes (T2D) receiving basal insulin therapy, this study evaluated the effectiveness of physician-targeted education for optimizing glycemic management in these patients in China.
Methods: This multicenter open-label observational study conducted across China had a baseline sample survey, followed by a 6-month education program, and ended with a post-education sample survey. Education based on T2D treatment guidelines was given at Months 1 and 3, and was reinforced by self-audit every month. Each hospital enrolled 100 patients with T2D receiving basal insulin at both the baseline and post-education survey. The primary outcome was the proportion of hospitals meeting individual improvement goals. The goal setting was based on the proportion of patients achieving HbA1c <7.0% in each hospital at the time of the baseline survey.
Results: Overall, the individual improvement goal was achieved by 35 centers (49%). Hospitals with poor glycemic management at the baseline survey had higher possibility to improve at post-education survey. Two large sample surveys at baseline and post-education showed improved glucose management among these hospitals. A higher proportion of patients achieved HbA1c <7.0% in the post-education survey (27.2% vs 36.5%; P < 0.001) with reduced HbA1c levels (8.10% vs 7.72%; P < 0.001). Questionnaires from 723 physicians showed that confidence and practice of basal insulin use were significantly improved.
Conclusions: Physician-targeted education improved glycemic management of patients with T2D in 71 hospitals in China, and was more effective at hospitals with poor glycemic management at the baseline survey.
背景: 由于尚无接受基础胰岛素治疗的2型糖尿病(type 2 diabetes, T2D)患者生活质量改善的研究, 本研究评估了以医生为目标的教育对优化中国此类患者血糖管理的有效性。 方法: 这是一项在中国进行的多中心、开放式、观察性研究, 研究首先进行了基线的抽样调查, 随后是为期6个月的教育项目以及教育后的抽样调查。基于T2D治疗指南的医生教育项目在第1和第3个月进行, 并通过每月自评加强教育效果。每家医院在基线和教育后调查中均招募了100名接受基础胰岛素治疗的T2D患者。主要结果为达到预设改善目标的医院比例, 目标的设定基于各医院基线调查时糖化血红蛋白(HbA1c)<7.0%的患者比例。 结果: 总计35个中心(49%)达到了预设的改善目标。基线调查时血糖管理较差的医院在教育后调查中, 达到目标的可能性更高。基于基线和教育后的两次大样本调查结果显示, 经过以医生为目标的教育, 总体的血糖管理有所改善。在教育后调查中患者HbA1c水平降低(8.10% vs. 7.72%；P<0.001), 且HbA1c <7.0%的比例增高(27.2% vs. 36.5%；P<0.001)。723名医生的问卷调查显示, 基础胰岛素使用的信心和应用能力显著提高。 结论: 在中国的71家医院开展的医生教育提升了他们对于T2D患者的血糖管理水平, 并且基线调查时血糖管理较差的医院提升效果更好。.
Keywords: 2型糖尿病; basal insulin; education; glycemic management; physician; type 2 diabetes; 医生; 基础胰岛素; 教育; 血糖管理.
© 2019 Sanofi (Beijing) Pharmaceuticals Co., Ltd. Journal of Diabetes published by John Wiley & Sons Australia, Ltd and Ruijin Hospital, Shanghai Jiaotong University School of Medicine.