BMJ子刊:不想用还是用不起?儿童和青少年更好的血糖管理依赖于CGM覆盖率和医保报销

2021-12-22 MedSci原创 MedSci原创

确保糖尿病管理技术的覆盖率,特别是在年轻人群中,应该是一项政策的优先事项。

胰岛素泵和连续血糖监测 (CGM) 系统在 1 型糖尿病患者中的使用越来越受欢迎。与每日多次注射相比,使用胰岛素泵已被证明可降低青少年及儿童的HBA1c水平,虽然其他血糖结果中几乎没有描述差异。此外,集成CGM系统的使用已证明可以降低低血糖的频率和严重程度。

据报道,佩戴这些设备的人增加了灵活性和幸福感。尽管有这些好处,但在医疗保健系统覆盖范围、临床医生的咨询作用以及个人和家庭偏好方面,各国之间存在相当大的差异。此外,糖尿病患者的社会经济背景和医疗保健专业人员 (HCP) 的工作情况都可能间接影响推荐糖尿病技术的意愿。通过本次调查,旨在全面评估医生推荐或不推荐儿童和青少年使用糖尿病设备的原因。

研究组使用了由 Survey Monkey Inc(美国加利福尼亚州圣马特奥)提供的电子调查。该调查覆盖 2300名HCP。调查问题分为四个主题:(1)HCP 的基线概况;(2) HCP 对启动胰岛素泵的适应症和禁忌症的推荐、使用和相关性的意见);(3) HCP对推荐和使用CGM的意见;(4)个人年龄、严重低血糖史、糖尿病酮症酸中毒史、血糖控制、家庭组成、父母职业、医疗保险、收入、居住地、父母识字、移民、宗教信仰、语言理解和社会支持。

接受HCP咨询的同意或同意开始胰岛素泵治疗的患者的百分比

研究组分析了来自49个国家的247份回复。尽管胰岛素泵和CGM在受访者中广泛使用并强烈推荐,但它们的使用受到医疗保健覆盖范围以及保险的影响。个人偏好和治疗费用被认为是拒绝糖尿病技术的主要原因。父母的教育水平、语言理解和收入是影响 HCP 推荐糖尿病技术的最相关的社会经济因素,而性别、宗教信仰和种族/民族或公民身份的相关性最低。

处方或推荐胰岛素泵时社会经济因素的相关性

总而言之,HCP非常支持让人们开始使用新的CGM技术。但是,设备的覆盖范围/保险严重影响了其推广及使用。因此,确保糖尿病管理技术的覆盖率,特别是在年轻人群中,应该是一项政策的优先事项。

参考文献:Dos Santos TJ, Dave C, MacLeish S, et al Diabetes technologies for children and adolescents with type 1 diabetes are highly dependent on coverage and reimbursement: results from a worldwide survey BMJ Open Diabetes Research and Care 2021;9:e002537. doi: 10.1136/bmjdrc-2021-002537

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    2022-04-03 zhishijing
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    2022-11-07 gaoxiaoe
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