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Glucobay於中山醫學大學附設醫院之回溯性使用評估
Journal Volume
中山醫學雜誌 v14 n.1 p99-107
Date Issued
2010-07-28T08:57:13Z
Abstract
醣祿錠（Glucobay，學名Acarbose）是一種腸道內的α-葡萄糖水解酵素（α-glucosidase）抑制劑，臨床用於非胰島素依賴型糖尿病之治療。為實際了解降血糖藥物醣祿錠在臨床上的使用情形，本研究採電腦資料庫取樣2002年1月至7月間曾連續使用三個月以上醣祿錠之糖尿病患者，以人工審閱病歷記載之方式進行藥物使用評估，希望提供日後更合理、有效的用藥參考。本評估項目包括健保使用規範（適應症、治療監測）、藥物交互作用及用藥期間副作用之考量。結果顯示合乎健保使用規範者佔46.0%，不符合健保使用規範者佔54.0%。在藥品交互作用方面，與乙型腎上腺素性拮抗劑（β-adrenergic antagonists）併用時無選用β1-選擇性腎上腺素性拮抗劑（β1-selective blockers）佔37.5%；與強心劑毛地黃（Digoxin）併用時75.0%無採取適當監測措施，顯示降血糖藥物醣祿錠的用藥追蹤應再加強。建議醫師們應常規性的每月監測患者血糖值與HBA1C值，作為劑量調整的依據，在藥品交互作用及併發症方面亦應有所考量。而藥師們在衛教方面也應再嚴格要求，務必讓患者了解藥物的服用方法及可能會發生的副作用，並自我要求運動與飲食控制。
Glucobay (Acarbose), a competitive inhibitor of intestinal α-glucosidase, is used as monotherapy or in combination with other anti-diabetics (sulfonylureas, metformin or insulin) for the treatment of type 2 diabetes mellitus. To develop more effective and safe clinical guidelines for prescribing Glucobay, we performed a retrospective drug use evaluation (DUE) of patients who were listed on a computer database as having visited the outpatient department of Chung-Shan Medical University Hospital. Patients who had received Glucobay for at least 3 months during January 2002 to July 2002 were randomly selected and categorized based on National Health Insurance (NHI) guidelines, drug interactions and side effects. Of 102 patients enrolled, 40 were males. Average age was 62.0 ± 11.7 years. Glucobay prescription rate following NHI guidelines was 46.0%. However, prescription to 54.0% of total patients did not strictly adhere to NHI guidelines. Sixteen patients received Glucobay combined with β-adrenergic antagonists, and 37.5%(6/16) of these patients did not receive a β1-selective antagonist. Four patients on Glucobay were treated with digoxin. Digoxin serum levels or side effects secondary to digoxin therapy were not recorded in 75.0%(3/4) of these patients .A combination of Glucobay with other anti-diabetic drugs was prescribed to 98 patients. Dose was not changed according to blood glucose levels or clinical improvement in 26.5%(26/98) of these patients. Our results indicate that NHI guidelines regarding the use of oral antidiabetic drugs need stricter enforcement. This is especially applicable with respect to monitoring drug efficacy, adverse drug reactions and blood glucose and HbA1c levels.
Glucobay (Acarbose), a competitive inhibitor of intestinal α-glucosidase, is used as monotherapy or in combination with other anti-diabetics (sulfonylureas, metformin or insulin) for the treatment of type 2 diabetes mellitus. To develop more effective and safe clinical guidelines for prescribing Glucobay, we performed a retrospective drug use evaluation (DUE) of patients who were listed on a computer database as having visited the outpatient department of Chung-Shan Medical University Hospital. Patients who had received Glucobay for at least 3 months during January 2002 to July 2002 were randomly selected and categorized based on National Health Insurance (NHI) guidelines, drug interactions and side effects. Of 102 patients enrolled, 40 were males. Average age was 62.0 ± 11.7 years. Glucobay prescription rate following NHI guidelines was 46.0%. However, prescription to 54.0% of total patients did not strictly adhere to NHI guidelines. Sixteen patients received Glucobay combined with β-adrenergic antagonists, and 37.5%(6/16) of these patients did not receive a β1-selective antagonist. Four patients on Glucobay were treated with digoxin. Digoxin serum levels or side effects secondary to digoxin therapy were not recorded in 75.0%(3/4) of these patients .A combination of Glucobay with other anti-diabetic drugs was prescribed to 98 patients. Dose was not changed according to blood glucose levels or clinical improvement in 26.5%(26/98) of these patients. Our results indicate that NHI guidelines regarding the use of oral antidiabetic drugs need stricter enforcement. This is especially applicable with respect to monitoring drug efficacy, adverse drug reactions and blood glucose and HbA1c levels.