关键词: 糖尿病, 降血糖药, 用药频度, 合理用药

Abstract: Background　Glycemic control in diabetics is improving with the development of antidiabetic drugs and evidence-based medicine. As diabetes is a chronic disease requiring long-term and even lifetime drug treatment，ensuring medication safety has become a focus of the whole society，especially the majority of elderly diabetic patients and medical workers. Objective　To analyze the use of antidiabetic drugs in a diabetes population with relevant management from a district of Shanghai，to provide a reference for clinical rational drug use and diabetes management. Methods　Data of type 2 diabetics were collected from Shanghai's Songjiang District Health Management Platform，involving 31 199 cases registered from October 2016 to September 2017，including the number of antidiabetic drugs，DDDs，drug utilization index，HbA1c and glycemic monitoring method. Results　Among 31 199 diabetic patients，20 152（64.59%） used antidiabetic drugs. These antidiabetic drugs involved 7 kinds and 22 forms of hypoglycemic drugs，among which those with the greatest DDDs were biguanides，two sulfonylureas （including glimepiride and gliclazide），and two forms of insulin（ubilin and novoline） and one α-glucosidase inhibitor（acarbose）. Age-based analysis revealed that the utilization rate of antidiabetic drugs increased with age，so did the rate of combined use of antidiabetic drugs（P<0.05）. The rate of only using insulin injection decreased with age（P<0.05）. The rate of using both oral antidiabetic drugs and insulin injection increased with age （P<0.05）. The average dispensing times，total medication days，kinds of antidiabetic drugs，dosage of insulin and dosage of chemically synthesized oral antidiabetic drugs varied significantly across different age groups（P<0.05）. Glycemic monitoring was implemented in 61.33%（12 360/20 152） of the participants，with an annual monitoring frequency of 3 times per person. The distribution of glycemic monitoring methods varied significantly across different age groups（P<0.05）. The overall rate of meeting ideal and good target levels of HbA1c was lower in those using insulin injection than that of those using oral antidiabetic drugs（P<0.05）. Conclusion　In this community health center，the kinds of antidiabetic drugs are basically complete and their use is relatively reasonable. The first-choice drug is biguanides，followed by sulfonylureas. Most therapies consist of biguanides or sulfonylureas，used either alone or in combination.However，the use of insulin is extremely unreasonable，indicating that insulin therapy fails to exert its proper effect in the community. In addition，the rates of using antidiabetic drugs，good medication adherence and continuous glycemic monitoring in the diabetes group are low.