基于真实医疗大数据的2型糖尿病患者药物利用分析和疗效分析

Drug Utilization and Efficacy Analysis of Patients with Type 2 Diabetes Based on Real-World Medical Big Data

摘要: 目的：借助现实医疗大数据平台进行重庆市2型糖尿病患者的流行特征和药物利用情况分析；比较迟发性患者和早发性患者在药物利用和疗效的差异并分析其影响因素，为重庆市2型糖尿病患者临床用药提供参考。方法：选取“医渡云”医疗大数据平台2019年1月1日至2021年12月31日的2型糖尿病患者病历数据，使用卡方检验比较早发性患者和迟发性患者的流行特征、用药和疗效情况；使用非条件logistic回归分析患者疗效的影响因素，检验水准取α = 0.05。结果：早发性患者和迟发性患者在年龄、性别、病程、和合并症方面的差异有统计学意义。降血糖药物使用频率由高到低排名为：胰岛素、二甲双胍、α-葡萄糖苷酶抑制剂、钠–葡萄糖转运蛋白2抑制剂和磺脲类药物。早发性患者和迟发性患者用药结构的差异存在统计学差异，早发性患者更倾向于胰岛素相关的药物使用方案，而迟发性患者倾向于口服降血糖药物的药物治疗方案。重庆市2型糖尿病患者血糖控制达标率为53.4%，迟发性2型糖尿病患者血糖控制达标患者为53.5%，早发性2型糖尿病患者血糖控制达标患者为53.4。患者疗效的因素包括：病程、年龄、吸烟史、饮酒史、是否使用联合用药、糖化血红蛋白水平和合并症数量。早发性患者的疗效受病程、吸烟史、饮酒史、糖化血红蛋白影响，而迟发性患者的疗效受病程、饮酒史、合并症和是否联合用药影响。结论：重庆市2型糖尿病应关注早发性患者和迟发性患者用药结构的差异，临床上应重视病程长、具有吸烟饮酒史、糖化血红蛋白异常和具有合并症的患者，采取合理的联合用药方案来有效地控制血糖，提高患者的疗效。

Abstract: Objective: This study aims to analyze the characteristics and drug utilization of patients with type 2 diabetes in Chongqing using a real-world medical big data platform. It also aims to compare the differences in drug utilization and efficacy between late-onset patients and young-onset patients and to analyze their influencing factors, providing reference for clinical medication in patients with type 2 diabetes. Methods: The medical records of type 2 diabetes patients on the “Yidu Cloud” medical big data platform from January 1, 2019, to December 31, 2021, were selected. The characteristics, medication patterns, and efficacy were compared between young-onset patients and late-onset patients using the chi-square test. The influencing factors of patient efficacy were analyzed using unconditional logistic regression, with a significance level set at α = 0.05. Results: Statistically significant differences were observed between early-onset patients and late-onset patients in terms of age, gender, disease duration, and comorbidities. The frequency of hypoglycemic drug use, in descending order, was: insulin, metformin, α-glucosidase inhibitors, sodium-glucose transporter 2 inhibitors, and sulfonylureas. There was a significant difference in medication patterns between early-onset patients and late-onset patients, with young-onset patients more likely to use insulin-related regimens and late-onset patients more likely to use oral hypoglycemic drugs. The blood glucose control rate among type 2 diabetes patients in Chongqing city is 53.4%, and the rate of blood glucose control in late-onset patients is 53.5%, while the rate of blood glucose control in young-onset patients is 53.4%. Factors influencing patients’ outcomes included disease duration, age, smoking history, drinking history, concomitant medication use, glycosylated hemoglobin levels, and the number of comorbidities. The efficacy of early-onset patients was affected by disease duration, smoking history, drinking history, and glycosylated hemoglobin, while the efficacy of late-onset patients was influenced by disease duration, drinking history, comorbidities, and the use of combined medications. Conclusion: In managing type 2 diabetes in Chongqing, it is important to consider the difference in medication patterns between young-onset and late-onset patients. Clinical attention should be paid to patients with a long disease duration, a history of smoking and drinking, abnormal glycosylated hemoglobin, and more comorbidities. Adopting a reasonable combination medication regimen can effectively control blood sugar and improve patient outcomes.