前言：糖尿病人接受藥物控制一段時間，糖化血色素未達預期目標就應該調整或更換藥物，稱為強化治療。如果沒有增加藥物且糖化血色素還是未達預期目標，稱為臨床慣性。過去研究在病人世代定義，藥物使用數量，糖化血色素目標值，追蹤年數，糖化血色素檢驗頻率等方法學上有所不同，造成強化治療或臨床慣性研究結果比較的困難。
目的：本研究將針對上述因素採用系統性分析方法，探討台灣不同層級醫療單位強化治療與臨床慣性的現況。
方法：本研究使用2017-2021年的全民健保門診處方、醫令與檢驗結果檔案進行分析。以上述資料檔案建立一個五年糖尿病病人就醫歸戶醫院檔案，串聯檢驗檢查檔案得到糖化血紅素結果值。觀察已經使用1-4種口服降血糖藥物的病人未達4個糖化血紅素目標（7.5%，8.0%，8.5%與9.0%）不同時間，是否增加口服藥物品項或開始使用注射型降血糖藥物，估計強化治療（臨床慣性）的時間與比例。
結果：在2017到2021年健保資料庫中，符合每年具2次糖尿病診斷且有藥物處方的個案以4至5年皆可歸戶於同一間醫院的1,051,504病人進行分析。其中在2017年1月到2018年12月間具有連續6個月以上的1-4種口服降血糖藥物處方且無注射劑型的降血糖藥物共828,625申報件數，最後篩選口服降血糖藥物處方超過6個月後3個月內有糖化血紅素檢驗資料共241,169申報件數納入分析。超過糖化血紅素目標值7.5%，8.0%，8.5%，9.0%分別有各有70,129，41,292，25,070與15,499件。強化治療結果再以使用的口服降血糖藥物數目分為1，2，3與4種做分層分析。本研究最長追蹤時間到3.96年，強化時間會隨著目標值的設定上升而縮短，整體強化時間中位數在0.64-0.82年間。個案在納入研究後第36個月時，未達4個糖化血紅素目標（7.5%，8.0%，8.5%與9.0%）有強化的比例分別是43.8%，47.2%，49.7%與51.9%。以糖化血紅素目標值9.0%為例，使用1到4種口服降血糖藥物的強化比例分別是76.8%，58.6%，39.0%與27.4%。本研究族群中70%以上的病人已經使用了2-3種口服降血糖藥物，5-7%的病人使用了4種口服降血糖藥物。整體強化藥物的選擇以加上另一個口服降血糖藥物為主（70-79%），胰島素次之（16-25%），最後是GLP-1 RAs（4-5%）。已經使用的口服降血糖藥物種類數越多，選擇胰島素及GLP-1 RAs作為強化藥物的比例越高。不同院所層級分組分析4個糖化血紅素目標的強化治療情況：最高的都是區域醫院（45.8%-53.7%），最低是醫學中心（41.4%-45.3%）。強化時間中位數最短的院所層級是地區醫院（0.61-0.78年），時間最長的是診所（0.76-0.86年）。
結論：由於使用口服降血糖藥物至少6個月後的3個月內有糖化血色素檢驗為本研究納入條件之一，可能篩選出疾病控制較佳像是加入糖尿病論質計酬計畫的病人。但與其他國家的研究相比，本研究結果的強化比例並不高。代表台灣即使在照護較為周全的族群中臨床慣性仍然不佳，在糖尿病的臨床管理上仍存在著很大的挑戰。

Background: Diabetes management involves adjusting medications if HbA1c targets aren't met, termed treatment intensification. Clinical inertia arises when medications remain unchanged despite inadequate HbA1c levels. Comparing studies is challenging due to varying factors. This study analyzes treatment intensification and clinical inertia in Taiwan's healthcare facilities. Objectives: This study investigates treatment intensification and clinical inertia in Taiwan's diabetes patients across different healthcare facilities. Using 2017-2021 data, it explores treatment patterns and the proportion receiving intensified therapy based on HbA1c levels. Methods: Data from Taiwan's National Health Insurance database were analyzed, creating a five-year diabetes patient database linking medical records and HbA1c values. The study examines time to treatment intensification and the proportion receiving intensified treatment, via oral antidiabetic drugs (OADs) or injectable insulin, focusing on patients using 1-4 OADs with unmet HbA1c targets (7.5%, 8.0%, 8.5%, 9.0%). Results: Overtime, the proportions of patients receiving treatment intensification increased, reaching 45.7%-53.7% at the end of the study. However, patients using a higher number of OAD types had lower intensification proportions. Regarding medication choices for intensification treatment, the majority of patients opted to add another OAD, followed by insulin, and a small percentage chose GLP-1 RAs. The choice of insulin and GLP-1 RAs increased with the number of OADs used. Furthermore, the study examined intensification proportions and duration among different levels of healthcare institutions. Regional hospitals had the highest intensification proportions, while medical centers and clinics had lower proportions. District hospitals had the shortest median duration of intensification, while clinics had the longest duration. Conclusion: There is still a high proportion of patients who use multiple oral antidiabetic drugs and tend to choose another oral medication for intensification treatment instead of insulin as recommended by guidelines. Clinical inertia remains a challenge in diabetes treatment in Taiwan.

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