临床药师干预优化2型糖尿病病人胰岛素使用效果评价

目的对临床药师干预优化2型糖尿病病人胰岛素使用效果进行评价。方法选择136例行胰岛素皮下注射的2型糖尿病（T2DM）病人，采用随机数字表法将病人分为2组。对照组（68例）采用传统健康教育，观察组（68例）采用临床药师参与胰岛素用药指导，2组均干预3个月。比较2组干预前后病人对胰岛素使用认知水平、胰岛素保存及使用依从性、血糖水平、用药过程中出现问题差异。结果观察组胰岛素名称、胰岛素种类、保存方法、针头规格、注射前注意事项、注射方法、注射中注意事项、针头使用、进餐时间、低血糖自救评分、MMAS-8评分、胰岛素使用依从性良好率均明显高于对照组（P＜0.01）。观察组干预后空腹血糖、餐后2 h血糖和糖化血红蛋白均明显低于对照组（P＜0.01），C肽水平明显高于对照组（P＜0.01）。观察组研究期间病人出现惧怕胰岛素注射、低血糖、注射部位皮肤异常、注射时疼痛和针尖漏液发生率均低于对照组（P＜0.05~P＜0.01）。结论临床药师参与对老年糖尿病病人胰岛素使用指导可提高对胰岛素使用认知水平和用药依从性，维持血糖水平稳定，提高用药安全性。

Evaluation of the effects of clinical pharmacist intervention to optimize insulin use in patients with type 2 diabetes mellitus

ObjectiveTo evaluate the effects of clinical pharmacist intervention to optimize insulin use in patients with type 2 diabetes mellitus.MethodsA total of 136 type 2 diabetes mellitus(T2DM) patients treated with subcutaneous insulin were divided into the control group(68 cases) and observation group(68 cases) according to the random number table method.The control group was treated with the traditional health education, and the observation group was treated with the clinical pharmacists to participate in the guidance of insulin medication for 3 months.The differences of the cognitive level of insulin use, insulin preservation and compliance, blood glucose level and problems in the course of medication were compared between two groups before and after intervention.ResultsThe name, type and preservation method of insulin, needle specification, precautions before injection, injection method, precautions during injection, needle use, mealtime, score of hypoglycemia self-help, MMAS-8 score and good compliance rate of insulin use in observation group were higher than those in control group(P < 0.01).After intervention, the levels of fasting blood glucose, 2 h postprandial blood glucose and HbA1c in observation group were significantly lower than those in control group(P < 0.01), and the C-peptide level in observation group was significantly higher than that in control group(P < 0.01).During the study period, the incidence rates of fear of insulin injection, hypoglycemia, abnormal skin at the injection site, pain during injection and tip leakage in observation group were lower than those in control group(P < 0.05 to P < 0.01).ConclusionsThe participation of clinical pharmacists in the guidance of insulin use in elderly diabetic patients can improve the cognitive level of insulin use and medication compliance, maintain the stability of blood glucose level, and improve medication safety.