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Insulinska terapija dijabetes melitusa tip 2 kod radno aktivnog stanovništva Doma zdravlja Smederevo
Insulin therapy in active population among patients with type 2 diabetes mellitus in Health center Smederevo
Sažetak
Uvod. Diabetes mellitus {DM), kao jedna od vodećih hroničnih bolesti od većeg socioekonomskog značaja, predmet je ovog istraživanja radno aktivne populacije dijabetičara tip 2, starosti 51-60 godina, na insulinskoj terapiji, u periodu od 1. novembra 2010. do 30. novembra 2012. u ambulanti izabranog lekara u Domu zdravlja Smederevo. Danas u svetu ima 250 miliona dijabetičara, a pretpostavlja se da će za 20 godina taj broj biti oko 350 miliona. U Srbiji je 600.000 obolelih od dijabetesa, od toga je 85% sa DM tip 2. Insulinska terapija se primenjuje kod DM tip 2 u slučajevima kada prethodnom terapijom nije ostvarena dobra glikoregulacija. Insulini koji se koriste su humani i insulinski analozi, sintetski, moderni insulini sa karakteristikama najsličnijim fiziološkom insulinu. Osnovna podela insulina po dužini dejstva je na kratko dejstvo, srednje dugo dejstvo i fiksne mešavine u različitom odnosu. Cilj rada. Utvrditi vrste insulina kod ove grupe pacijenata, odnos humani insulin/insulinski analozi i utvrditi vrednosti glokoziliranog hemoglobina (HbA1c) u odnosu na vrstu insulina. Metod. Sprovedena je prospektivna studija pacijenata putem redovnih kontrola, evidentiranih u zdravstvenim kartonima iste grupe pacijenata. Na početku studije bilo je 62, a na kraju 54 ispitanika i praćeni su dve godine. Rezultati. Novembar 2010: 62 ispitanika oba pola, starosti od 51 do 60 godina - 34 (54,83%) žene i 28 (45,17%) muškaraca. Svi pacijenti su bili na insulinu duže od godinu dana, a pre insulina su bili loše regulisani i imali HbA1c veći od 7%. Rezultati su pokazali da je zastupljenost humanih insulina bila kod 23 (37,10%), a insulinskih analoga kod 39 (62,90%) ispitanika. Vrste insulinske terapije: najčešće bifazni aspart insulin kod 27 (43,54%); intenzivirana insulinska terapija insulinskim analozima kratko i srednje delujućim u 4 doze kod 12 (19,35 %); konvencionalna terapija u dve doze, najčešće Mixtard 30, kod 11 (17,74%); intenzivirana insulinska terapija humanim insulinima kratko i srednje delujućim kod 9 (14,51%) i najmanje zastupljena terapija humanim bazalnim insulinom u jednoj ili dve doze kod 3 (4,86%) pacijenta. Prosek HbA1c kod pacijenata na humanim insulinima je bio 8,4%, a na insulinskim analozima 7,9%. Novembar 2012: 54 ispitanika iste grupe, 35 (64,81%) žena i 19 (35,19%) muškaraca. Prebacivanje sa humanih insulina na insulinske analoge je rađeno po kriterijumima Službenog glasnika iz 2010, 2011 i 2012. godine. Na humanom insulinu je bilo 17 (31,49%) ispitanika, na insulinskim analozima 37 (68,51%). Vrste insulinske terapije: najčešće intenzivirana insulinska terapija analozima kod 20 (37,03%); bifazni aspart insulin kod 15 (27,77%); intenzivirana insulinska terapiJa humanim insulinima kod 11 (20,37%); konvencionalna terapija Mixtard 30 kod 5 (9,25%); bazalni insulinski analog glargin kod 2 (3,70%) i najmanje zastupljen humani bazalni insulin kod 1 (1,88%) pacijenta. Prosek Hb1c na humanim insulinima je bio 8,3%, na insulinskim analozima 7,1%. Zaključak. U analiziranom periodu je veća zastupljenost insulinskih analoga u odnosu na humane insuline. Vrste insulinske terapije se razlikuju 2010. i 2012. god. Godine 2010. je na prvom mestu bila terapija bifaznim aspart insulinom, a 2012. intenzivirana terapija insulinskim analozima; HBA1c je u ispitivanim periodima bio bolji u grupi na insulinskim analozima. Trend povećanja broja pacijenata na insulinskim analozima je u skladu sa evropskim preporukama, zbog povoljnih karakteristika njihovog delovanja u odnosu na humane insuline; takođe je bolja glikoregulacija, što se vidi na parametru HbA1c i odlaganju pojava hroničnih komplikacija DM tip 2, a time i smanjenju kardiovaskularnog rizika.
Abstract
Introduction: Diabetes mellitus (DM), one of the leading chronic diseases with prominent socioeconomic importance, is an object of this research of active population of diabetics aged 51-60 years, receiving insulin therapy in the period between 01/11/2010 and 30/11/2012 in the general practice office in Health center Smederevo. Estimated number of diabetics in the world approximates 250 millions, and prognosis is that in next 20 years this number will approach 350 millions. Number of diabetics in Serbia is approximately 600,000 and 85% of them suffers from type 2 DM. Insulin therapy in type 2 DM is introduced in cases with insufficiently regulated blood glucose. Applied insulin preparations are human insulins and insulin analogues, synthetic modern insulins with characteristics almost identical to the physiologic insulin. Basic insulin varieties, according to duration of action, are short acting, intermediate acting, and fixed combinations at different ratio. Objective: To ascertain types of insulin preparations utilized in these patients, ratio between types of insulin utilized in therapy of these patients (human insulin vs. insulin analogues) and to find relation between values of glycosylated hemoglobin (HbA1c) and insulin therapy. Method: Prospective study based on medical documentation of regular check-ups. Duration of the study was 2 years. At the beginning study comprised 62, and at the end 54 subjects Results: November 2010: 62 subjects aged 51-60 years, of both genders - 34 (54.38%) female and 28 (45.17%) male. All patients were on insulin therapy for more than a year, and before insulin therapy blood-glucose was poorly regulated, with HbA1c higher than 7%. Results demonstrated that 23 patients (37.10%) were treated with human insulin, and 39 (62.90%) with insulin analogues. Types of insulin therapy: the most often biphasic aspartate insulin in 27 (43.54%); intensified insulin therapy with insulin analogues of short and intermediate duration of action in four doses in 12 cases (19.35%); conventional therapy in two divided doses, the most often Mixtard 30, in 11 (17.74%); intensified insulin therapy with human insulin of short and intermediate action in 9 (14.51%), and therapy with human basal insulin in single, or two divided doses, in 3 (4.86%) patients. Average HbA1c was 8.4% in patients treated with human insulin, and 7.9% in patients treated with insulin analogues. November 2012: 54 subjects from the same group, 35 female (64.81%) and 19 (35.19%) male. Transfer from human insulin therapy to insulin analogues therapy was performed according to Official Gazette from 2010, 2011 i 2012. year. Human insulin therapy received 17 (31.49%) and insulin analogues were therapy in 37 (68.51%) patients. Types of insulin therapy: Intensified insulin therapy with insulin analogues in 20 (37.03%); biphasic aspartate insulin in 15 (27.77%), intensified insulin therapy with human insulin in11 (20.37%), conventional therapy Mixtard 30 in 5 (9.25%);basal insulin analogue glargin in 2 (3.70%); and human basal insulin in 1 (1.88%) of patients. Average HbA1c was 8.3% in patients treated with human insulin, and 7.1% in patients treated with insulin analogues. Conclusion. In analyzed period quota for insulin analogues was bigger than for human insulin. Type of insulin therapy in 2012 differs from therapy in 1910. During 2010. the most utilized therapy was biphasic aspartate insulin, and in 2012. the intensified therapy with insulin analogues. HbA1c was better in patients receiving insulin analogues is concordant with European recommendations, based on better action and better glucoregulation compared to human insulin. This fact is discernible from the parameter HbA1c and delayed appearance of chronic complications and decrease of cardiovascular risk.
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