へき地医療機関における糖尿病診療の横断研究 : HbAlc値, 使用薬剤の割合, 若手医師が診療で感じる困難さ  [in Japanese] A cross-sectional study of diabetic patients in rural clinicsHbAlc (National Glycohemoglobin Standardization Program ; NGSP), the percentage of diabetes drug usage in diabetic patients, and the difficulties experienced in clinical practice by young doctors  [in Japanese]

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Abstract

<b>要 旨</b><br><b>目的</b> : へき地医療機関にて糖尿病患者におけるHbA1c値, 使用薬剤割合, 若手医師が診療で感じる困難さを明らかにする. <br><b>方法</b> : デザインは横断研究, 調査期間は2011年5月23日∼2011年6月17日, 対象施設は山口県のへき地医療機関, 対象者は糖尿病治療薬内服中の患者, 調査参加医師は対象施設に勤務する糖尿病非専門医, 診療情報は診療録から抽出, 医師へは自己記入式質問紙にて調査した. <br><b>結果</b> : 対象糖尿病患者の年齢は73.8±9.6歳, 男性56.6%, 直近のHbA1c値7.0±0.8%, 調査対象医師は5名 (男性4名, 年齢28∼34歳, 診療経験4∼10年) である. 薬剤割合はスルホニル尿素薬 (SU) (31%), αグルコシダーゼ阻害薬 (24%), ビグアナイド薬 (BG) (20%), チアゾリン誘導体 (TZD) (9%), 速効型インスリン分泌促進薬 (7%), DPP-4阻害薬 (6%), インスリン製剤 (Insulin) (3%), GLP-1アナログ (0%) だった. へき地医療機関でない一般開業医の比較しSU (31%vs. 52%) とInsulin (3%vs. 8%) の割合が少なく, BG (20%vs. 5%) とTZD (9%vs. 3%) の割合が多く, 両群の割合は異なっていた (p=0.003). 困難さは生活・診療全般, 糖尿病の専門的知識・経験など8項目が抽出された. <br><b>結論</b> : へき地医療機関で勤務する若手医師の外来を受診する糖尿病患者のHbA1c値は, 先行研究での他の医療環境での値とほぼ同程度であったが, 使用薬剤の傾向は異なっていた. また糖尿病診療で遭遇する困難さが8項目抽出された.

<b><i>Abstract</i></b><br><b>Introduction</b> : We investigated glycated hemoglobin (HbA1c) National Glycohemoglobin Standardization Program (NGSP) levels, and the percentage of antidiabetic drug use in patients with diabetes mellitus followed up in rural clinics as well as the difficulties experienced by young doctors in treating them.<br><b>Methods</b> : We conducted a cross-sectional study in 5 rural clinics in the Yamaguchi Prefecture from May 17, 2011 to June 23, 2011. Thestudy included patients with diabetes mellitus who were treated by nonspecialist doctors. Clinicaldata was extracted from medical records, and the doctors filled a self-completed formula questionnaire.<br><b>Results</b> : Mean age [±standard deviation (SD) ] of the subjects was 73.8±9.6 years and 56.6% were males. Five doctors (4 males, aged 28-34 years) having a clinical experience of 4-10 years were included. The mean HbA1c (NGSP) level (±SD) was 7.0%±0.8%. The percentage of antidiabetic drugs used are listed in descending order as follows : sulphonylureas (SU) (31%), alpha-glucosidase inhibitors (α-G) (24%), biguanides (BG) (20%), thiazolidinediones (TZD) (9%), rapid insulin secretagogues (7%), dipeptidyl peptidase (DPP) -4 inhibitors (6%), insulin (3%), and glucagone-like peptides (GLP) -1 (0%). The doctors surveyed in rural areas prescribed a lower the percentage of SUs (31% vs. 52%) and insulin (3% vs. 8%) and a higher percentage of BGs (20% vs. 5%) and TZDs (9% vs. 3%) when compared with general practitioners outside rural areas. The percentage of antidiabetic drugs used were different in both groups (p=0.003). The difficulties experienced by the young doctors in treating the patients with diabetes mellitus were classified into 8 categories (general condition, professional knowledge, experience with diabetes etc.).<br><b>Conclusion</b> : We determined the HbA1c (NGSP) levels and the percentage of antidiabetic drug usage in patients with diabetes mellitus as well as the differences in the general trend followed by doctors in and outside rural areas treating them and the difficulties experienced by young doctors in treating patients with diabetes mellitus in rural clinics.

Journal

  • An Official Journal of the Japan Primary Care Association

    An Official Journal of the Japan Primary Care Association 35(3), 204-208, 2012-09-24

    JAPAN PRIMARY CARE ASSOCIATION

References:  9

Codes

  • NII Article ID (NAID)
    10031143341
  • NII NACSIS-CAT ID (NCID)
    AA12479442
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    21852928
  • NDL Article ID
    025039252
  • NDL Call No.
    Z19-983
  • Data Source
    CJP  NDL  J-STAGE 
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