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1、DiabetesMedication: InitiationandIntensificationGregoryA.Nichols,PhDAnnualCollaborativeDiabetesEducationConferenceforHealthProfessionalsJanuary21,2012DisclosuresEmployedbyKaiserPermanenteCenterforHealthResearch,Portland,OregonGovernmentResearchFunding:NationalIn
2、stituteofDiabetesandDigestiveandKidneyDisorders(NIDDK)NationalHeart,LungandBloodInstitute(NHLBI)AgencyforHealthcareResearchandQuality(AHRQ)IndustryFunding:GlaxoSmithKlineMerck&Co.NovartisPharmaceuticalsTethysBioscienceTakedaPharmaceuticalsAmericaNovoNordiskAstra
3、ZenecaAmgenTheNeedforDiabetesPharmacotherapyDiabetesisametabolicconditioncharacterizedbyhyperglycemiaInsulinResistanceInsufficientinsulinproductionProgressive,typicallyrequiringongoingtherapyintensificationGeneralBenefitsofMetforminReduceshepaticglucoseproductio
4、ninthepresenceofinsulinAtleastweightneutralMaybecardioprotectiveMayreducecancerriskDefinitelyprevents/delaysdiabetesinsomeat-riskindividualsMetforminInitiationat DiabetesDiagnosisRecommendedbyEASD/ADADoesearlyvs.latemetformininitiationandmoreintensivedosing:Incr
5、easethelikelihoodofsuccessfulmetformintherapy?Prolongitssuccess?StudySiteandSampleSelectionKaiserPermanenteNorthwestAlldiabetespatientswhoinitiatedmetforminmonotherapyasfirst-everanti-hyperglycemicdrug,2004-2006Membersfor>1yearpre-and6monthspost-metformininitiat
6、ionHbA1cmeasuredpre-andpost-metformininitiationStudySamplen=3,116StudySamplen=3,116PrimaryFailureorNon-Adherencen=518(16.6%)ContinuedMetforminn=2,598(83.4%)StudySamplen=3,116PrimaryFailureorNon-Adherencen=518(16.6%)ContinuedMetforminn=2,598(83.4%)NoRefills,n=210
7、<90DaysSupply,n=289Added2ndAgent,n=19StudySamplen=3,116PrimaryFailureorNon-Adherencen=518(16.6%)ContinuedMetforminn=2,598(83.4%)NoRefills,n=210<90DaysSupply,n=289Added2ndAgent,n=19A1CMeasured6MonthsPost-Metforminn=2,508StudySamplen=3,116PrimaryFailureorNon-Adher
8、encen=518(16.6%)ContinuedMetforminn=2,598(83.4%)NoRefills,n=210<90DaysSupply,n=289Added2ndAgent,n=19A1CMeasured6MonthsPost-Metforminn=2,508NeverAchieved<7%n=709(28.3%
