目的 贯彻落实河北省卫生健康委《河北省公立医疗机构用药目录遴选评价管理指南》的要求,为医院决策者遴选、临床合理使用磺脲类降糖药物提供循证依据。方法 依照指南制定的百分制评分体系,参考药品说明书、临床指南和文献,从安全性、有效性、经济性、创新性、适宜性和可及性等6个方面分别对格列喹酮片、格列齐特缓释片和格列美脲片进行医院卫生技术评估。结果 格列喹酮片、格列齐特缓释片和格列美脲片最终分值分别为72.5、71和73分;3者用于治疗2型糖尿病均可有效降低患者的餐后血糖;患者可结合自身条件及需求合理选择使用药品;与其他药物合用时应注意药物相互作用的影响,需密切监测血糖,防止低血糖的发生。结论 本次卫生技术评估可为医疗机构开展药品评价与遴选提供指导,同时为临床合理使用磺脲类降糖药提供循证依据。
Abstract
OBJECTIVE To implement the requirements of Hebei Provincial Health Commission "Guidelines for the Selection, Evaluation and Management of Drug Catalogue in Public Medical Institutions in Hebei Province", and provide evidence-based basis for decision makers to select and rationally use sulfonylureas drugs in hospitals. METHODS According to the 100-point scoring system specified in the guidelines and referring to the drug instructions, clinical guidelines and literature, the hospital health technology was evaluated from six aspects, including safety, efficacy, economy, innovation, suitability and accessibility. RESULTS The final scores of gliquidone, gliclazide and glimepiride were 72.5, 71 and 73, respectively. All of them can effectively reduce postprandial blood glucose in patients with type 2 diabetes, with good safety. In addition, a variety of enzyme inducers or inhibitors can interact with SUs, so attention should be paid to the influence of drug interactions during the application of patients. Patients with type 2 diabetes can choose drugs according to their own conditions and needs. When combined with other drugs,blood glucose should be closely monitored to prevent the occurrence of hypoglycemia. CONCLUSION This health technology assessment can provide guidance for medical institutions in drug evaluation and selection, and provide evidence-based basis for clinical rational use of sulfonylureas hypoglycemic drugs.
关键词
医院卫生技术评估 /
医疗机构药品遴选 /
磺脲类药物 /
药品安全性 /
药品有效性
{{custom_keyword}} /
Key words
hospital-based health technology assessment /
drug selection /
sulfonylureas /
safety /
effectiveness
{{custom_keyword}} /
中图分类号：
R969.3
{{custom_clc.code}}
({{custom_clc.text}})
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] MEN P, TANG H L, ZHAI S D. Processes and methods of health technology assessment on medications[J]. Chin Heal Insur (中国医疗保险),2015, (10):57-59.
[2] LÜ L T, FU J L, LIN X, et al. Dilemma and outlet of hospital based health technology assessment in China[J]. Chin Hosp Manag (中国医院管理),2019, 39(2):7-10.
[3] GUO Z D, CHI X Y Z, MAO Y W, et al. The current status study on health technology assessment programs funded by National Natural Science Foundation of China[J]. Chin Health Resources(中国卫生资源), 2016, 5(19):440-443.
[4] MU Y M, YANG W Y, ZHU D L, et al. Chinese expert consensus statement on sulfonylureas in the clinical practice: 2016 updated[J]. Chin J Diabetes Mellitus(中华糖尿病杂志),2017, 14(1):447-498.
[5] TANG H L, MEN P, ZHAI S D, et al. Introducing and exploring the method of rapid review on drugs[J]. Clin Med J (临床药物治疗杂志), 2016, 14(2):1-4.
[6] LI X T, ZHANG Q. Development and reference of health technology assessment in the United States[J]. Sci-Tech Develop Enterpr(企业科技与发展),2018, 18(11):247-248.
[7] HUANG J, ZHANG Y G, LIU Y Q, et al. Briefly introduction of mini health technology assessment[J]. Chin J Evid-Based Med (中国循证医学杂志), 2014, 14(8):901-904.
[8] GUO X H, LV X F, HAN P, et al. Efficacy and safety of glimepirea initiation therapy for newly diagnosed type 2 diabetes: a subgroup analysis of the GREAT study[J]. Chin J Endocrinol Metab(中华内分泌代谢杂志), 2012, 28(12):979-983.
[9] BRANCH OF ORGAN TRANSPLANTATION OF CHINESE MEDICAL ASSOCIATION. Technical specifcation for diagnosis and treatment of post transplantation diabetes mellitus in China (2019 edition)[J]. Organ Transplant(器官移植),2019,10(1):1-9.
[10] JIANG S. Interpretation of oral pharmacologic treament of type 2 diabetes mellitus:a clinical practice guidline update from the American college physicians[J]. Chin Gener Pract (中国全科医学), 2017, 20(33):4091-4095, 4104.
[11] Polish diabetes association. 2018 Guidelines on the management of diabetic patients[J]. Clin Diabetol, 2018, 7(1):1-90.
[12] Organ Transplantation Branch of Chinese Medical Association. Chinese guidelines on the diagnosis and treatment of diabetes after organ transplantation[J]. Organ Transplant(器官移植), 2016,7(6):407-416.
[13] Chinese Diabetes Society. Guidelines for the prevention and control of type 2 diabetes in China (2017 Edition)[J]. Chin J Pract Intern Med (中国实用内科杂志), 2018, 38(4):292-344.
[14] Chinese Diabetes Society. Guidelines for Chinese diabetes care and education[S]. 2009-10-30.
[15] American Diabetes Association. Executive summary:Standards of Medical in Diabetes 2012[S]. 2012.
[16] MU Y M, LI C L, JI L N, et al. Expert consensus on the clinical application of metformin (2018)[J]. Chin J Diabetes(中国糖尿病杂志), 2019, 27(3):161-173.
[17] Chinese Diabetes Society. Experts' consensus on glycated HBA1c target and management algorithm for Chinese adults with type 2 diabetes[J]. Chin J Endocrinol Metabol(中华内分泌代谢杂志), 2020, 36(1):14-24.
[18] Chinese Society of Endocrinology. Expert consensus on oral hypoglycemic drug combination therapy for type 2 diabetes mellitus in Chinese adults[J]. Chin J Endocrinol Metabol(中华内分泌代谢杂志), 2019, 35(3):190-199.
[19] MU Y M, YANG W Y, ZHU D L, et al. Chinese expert consensus statement on sulfonylureas in the clinical practice: 2016 updated[J]. Drug Eval(药品评价), 2017, 14(1):5-12.
[20] Chinese Society of Endocrinology. Chinese expert consensus on the clinical application of glaziquantel[J]. Chin J Endocrinol Metabol(中华内分泌代谢杂志), 2017, 5(33):363-366.
[21] Division of Endocrinology and Metabolism of Chinese Medical Association. Consensus of Chinese experts on oral hypoglycemic drug therapy for patients with type 2 diabetes complicated with chronic kidney disease [J]. Chin J Endocrinol Metab(中华内分泌代谢杂志), 2019, 35(6):447-454.
[22] Diabetes Professional Committee of Chinese Research Hospital Association. Experts consensus on the grading medical care and quality management of type 2 diabetes mellitus [J]. Chin J Front Med (中国医学前沿杂志), 2020, 12(5):38-52.
[23] Chinese Society of Endocrinology. Expert consensus on the application of insulin secrete agents in Chinese adults with type 2 diabetes mellitus[J]. J Diabetes World(糖尿病天地), 2016, 10(12):549-553.
[24] ORME1 M, FENICI2 P, LOMON I D. A systematic review and mixed-treatment comparison of dapagliflozin with existing anti-diabetes treatments for those with type 2 diabetes mellitus inadequately controlled by sulfonylurea monotherapy[J]. Diabetol Metab Syndr, 2014, 6(73):1-13.
[25] CAI X L, LUO Y Y, HAN X Y. Meta-analysis of the efficacy and safety of nateglinide in Asian type 2 diabetes[J]. Chin J Diabetes, 2013, 21(10):913-917.
[26] YANG R, CUI X Y, LI Y. Effectiveness and economy of glibenclamide versus glibenclamide in the treatment of type 2 diabetes mellitus-systematic evaluation[J]. J China Pharm(中国药房), 2015, 26(6):777-780.
[27] YANG Z J, YANG W Y, LÜ X F, et al. Comparison of the clinical efficacy and safety of metformin in combination with glaziquantel or acarbose in the treatment of type 2 diabetes: a multicenter, randomized, open, parallel-group controlled study[J]. Chin J Diabetes Mellitus(中华糖尿病杂志), 2009, 1(3):170-173.
[28] EREM C, OZBAS H M, NUHOGLU I,et al. Comparison of effects of gliclazide, metformin and pioglitazone monotherapies on glycemic control and cardiovascular risk factors in patients with newly diagnosed uncontrolled type 2 diabetes mellitus [J]. Exp Clin Endocrinol Diabetes, 2014, 122(5): 295-302.
[29] CHEN H, LI J H, ZHUANG W B. Evaluation of the efficacy and safety of repaglinide and gliclazide in treatment of type 2 diabetes by Meta-analysis[J]. J Guangdong Pharm Univ (广东药学院学报), 2012, 28 (6):652-656.
[30] HUANG Y H. Comparison of efficacy between glimepiride and gliclazide in the treatment of type 2 diabetes mellitus[J]. Cardiov Disease J Integ Tradit Chin West Med(中西医结合心血管病杂志), 2016, 4 (18):49-50.
[31] MEMY H H, GAMIL M A. Effects of metformin plus gliclazide versus metformin plus glimepiride on cardiovascular risk factors in patients with type 2 diabetes mellitus[J]. Pak J Pharm Sci, 2015, 28 (5):1723-1730.
[32] LI Y, LUO H, WANG Y Z, et al. A systematic review of glimepiride compared to other sulfonylurea drugs for type 2 diabetes mellitus[J]. Chin J Pharmacoepidemiol (药物流行病学杂志), 2015, 24 (7):381-387.
[33] GUO X H, LÜ X F, HAN P, et al. Efficacy and safety of glimepiride as initial treatment in Chinese patients with type 2 diabetes mellitus[J]. Curr Med Res Opin, 2013, 29 (3):169-174.
[34] LIU H Y, CHENG G. Meta-analysis on the efficacy and safety of sitagliptin and glimepirea combined with metformin in the treatment of type 2 diabetes mellitus[J]. Clin J Med Off(临床军医杂志), 2020, 4 (82):185-188.
[35] LÜ L T, FU J L, LIN X. Dilemma and outlet of hospital-based health technology assessment in China[J]. Chin Hosp Manag (中国医院管理), 2019, 39 (2):7-10.
[36] LÜ L T, FU L H. Exploration of the introduction of medical technology assessment into medical technology management in China[J]. Chin Hosp Manag(中国医院管理), 2016, 36 (12):17-20.
{{custom_fnGroup.title_cn}}
脚注
{{custom_fn.content}}
PDF(1158 KB)
