胰岛素集采项目对特殊门诊2型糖尿病患者用药结构的影响及推广应用

doi:10.5246/jcps.2026.04.027

摘要/Abstract

摘要：

本研究旨在探讨胰岛素集采项目对特殊门诊2型糖尿病患者用药结构的影响及临床关联性。采用回顾性队列研究设计, 选取2023年1月至2024年3月在某院内分泌特殊门诊就诊且符合严格入排标准的2型糖尿病患者280例, 按照胰岛素集采政策实施前后时间节点分为对照组(n = 140)和观察组(n = 140)。采用倾向性评分匹配方法控制两组基线特征差异, 确保两组在人口学特征、疾病严重程度、共病情况等方面具有可比性。记录并比较两组患者用药结构、经济负担、血糖控制情况、用药依从性及不良反应发生率, 通过多因素分析排除潜在混杂因素的影响。结果显示观察组长效胰岛素使用比例(58.57%)高于对照组(45.71%), 差异有统计学意义(P = 0.022); 观察组月度胰岛素费用支出(228.73 ± 52.16元)较对照组(432.65 ± 85.42元)显著降低, 降幅达47.13%(P < 0.001); 多因素分析显示, 在调整年龄、性别、病程等因素后, 观察组HbA1c(7.32% ± 1.15%)较对照组(7.85% ± 1.24%)降低(P = 0.001); 观察组MMAS-8评分(6.85 ± 0.92分)高于对照组(6.23 ± 1.15分, P < 0.001); 两组不良反应发生率比较差异无统计学意义(P = 0.706)。胰岛素集采项目与患者经济负担降低、用药结构优化及用药依从性提高存在关联, 同时与血糖控制改善相关。

关键词: 胰岛素, 集中带量采购, 2型糖尿病, 用药结构, 用药依从性, 血糖控制

Abstract:

To investigate the association between the insulin volume-based procurement program and changes in medication patterns as well as clinical outcomes among outpatients with type 2 diabetes mellitus (T2DM) in specialized clinics, a retrospective cohort study was conducted. A total of 280 T2DM patients who met rigorous inclusion and exclusion criteria and attended the endocrinology specialty clinic between January 2023 and March 2024 were included. Participants were assigned to either the control group (n = 140) or the observation group (n = 140) according to the implementation period of the insulin volume-based procurement program. Propensity score matching was applied to balance baseline characteristics between the two groups. Comparisons were made regarding medication patterns, economic burden, glycemic control, medication adherence, and adverse events. Multivariate analyses were further performed to adjust for potential confounders. Results showed that the proportion of long-acting insulin use in the observation group (58.57%) was significantly higher than that in the control group (45.71%, P = 0.022). The mean monthly insulin expenditure was markedly lower in the observation group (228.73 ± 52.16 CNY) than in the control group (432.65 ± 85.42 CNY), representing a 47.13% reduction (P < 0.001). After adjusting for age, sex, disease duration, and other covariates, the mean HbA1c level in the observation group (7.32% ± 1.15%) remained significantly lower than that in the control group (7.85% ± 1.24%, P = 0.001). The MMAS-8 adherence score was also higher in the observation group (6.85 ± 0.92) than in the control group (6.23 ± 1.15, P < 0.001). No significant difference was observed in the incidence of adverse events between groups (P = 0.706). In summary, the insulin volume-based procurement program was associated with a substantial reduction in patients’ economic burden, optimization of insulin utilization patterns, and enhanced medication adherence, ultimately contributing to improved glycemic control among T2DM outpatients in specialized clinics.

Key words: Insulin, Volume-based procurement, Type 2 diabetes mellitus, Medication patterns, Medication adherence, Glycemic control

Supporting:

陆玉丹, 徐灵源, 曾海生, 甘露, 黄静, 周歧骥. 胰岛素集采项目对特殊门诊2型糖尿病患者用药结构的影响及推广应用[J]. 中国药学(英文版), 2026, 35(4): 381-390.

Yudan Lu, Lingyuan Xu, Haisheng Zeng, Lu Gan, Jing Huang, Qiji Zhou. The influence of the insulin volume-based project on the medication structure of patients with type 2 diabetes in the special outpatient service, and its popularization and application[J]. Journal of Chinese Pharmaceutical Sciences, 2026, 35(4): 381-390.

图/表 4

Table 1. Comparison of general data between the two groups (n (%), x ± s).

Table 2. Comparison of insulin medication structures between the two groups (n (%)).

Table 3. Comparison of blood glucose control indicators between the two groups (x ± s).

Table 4. Comparison of medication adherence scores and classification between the two groups (scores: x ± s; classification: n (%)).

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