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目的基于疾病负担循证评价和遴选我国乡镇卫生院治疗糖尿病的基本药物。方法采用本系列研究之二制定的研究方法、标准和流程,循证评价和遴选治疗糖尿病药物。分别采用GRADE标准评价证据质量,RevMan 5.0分析软件进行统计分析。结果①最终纳入糖尿病诊疗指南6个,含3个循证指南,指南出版时间2006～2011年。②根据WHO EML、中国EML、中国国家处方集和各国指南推荐药物及其证据的数量和质量,推荐二甲双胍、格列吡嗪、格列本脲、罗格列酮、吡格列酮5种药物,并评价前3种药的国内证据。③该3种推荐药物国内均有相应剂型和规格上市。二甲双胍普通片、肠溶片及缓释胶囊对空腹血糖的成本–效果比分别为3.37、3.76和3.50;对餐后2小时血糖的成本-效果比分别为3.74、4.0和3.71。格列苯脲与格列美脲疗效的成本-效果比分别为11.23和13.81。结论我国基层医疗卫生机构治疗糖尿病推荐用药:①二甲双胍片剂/胶囊(0.250 g),禁用于肾功能不全。②格列苯脲片剂(2.5 mg),胶囊(1.75 mg);格列吡嗪片剂(2.5/5 mg),分散片(5 mg)。儿童、孕妇、哺乳期妇女、大手术围手术期、胰腺全切除术后患者、对磺脲类药物过敏或有严重不良反应的患者禁用。③建议循证制定符合我国乡院需求的标准诊疗指南,开展这3种药物治疗糖尿病的大样本、高质量临床研究和药物经济学研究。
Objective To evaluate and select the basic medicines for the treatment of diabetes in township hospitals based on the evidence of disease burden. Methods The research methods, standards and procedures developed in this series of studies, evidence-based evaluation and selection of drugs for the treatment of diabetes were developed. Grading standards were used to evaluate the quality of evidence, RevMan 5.0 analysis software for statistical analysis. Results ① The final diagnosis and treatment of diabetes guidelines included 6, with 3 evidence-based guidelines, guidelines published in 2006 to 2011. ② According to the quantity and quality of WHO EML, China EML, China National Prescription Set, and the national guidelines recommended drugs and their evidences, 5 drugs of metformin, glipizide, glibenclamide, rosiglitazone and pioglitazone were recommended and evaluated Domestic evidence of the first three drugs. ③ The three kinds of recommended drugs have the appropriate domestic dosage forms and specifications listed. The cost-effect ratios of metformin-normal tablets, enteric-coated tablets and slow-release capsules to fasting plasma glucose were 3.37, 3.76 and 3.50, respectively; and the cost-effectiveness ratios of blood glucose of 2 hours after meal were 3.74, 4.0 and 3.71, respectively. The cost-effectiveness ratios of glyburide to glimepiride were 11.23 and 13.81, respectively. Conclusions Our country grass-roots medical and health institutions to treat diabetes recommended drugs: metformin tablets / capsules (0.250 g), banned in renal insufficiency. ② glibenclamide tablets (2.5 mg), capsules (1.75 mg); glipizide tablets (2.5 / 5 mg), dispersible tablets (5 mg). Children, pregnant women, lactating women, major perioperative, pancreatectomy patients, allergic to sulfonylureas or patients with serious adverse reactions disabled. ③ It is recommended that evidence-based guidelines should be drawn up to meet the needs of rural hospitals in our country, and to carry out large samples, high-quality clinical studies and pharmacoeconomic studies on these 3 drugs for the treatment of diabetes.