Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 19. Diabetes Mellitus_Chinese Journal of Evidence-Based Medicine

Authors：

Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Township health center; Essential medicine; Evidence-based evaluation and selection; Diabetes mellitus

DOI：

10.7507/1672-2531.20120158

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Objective 　To evaluate and select essential medicine for diabetes mellitus based on the burden of disease.
Methods 　By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence.
Results 　(1) Six guidelines were included, three of which were evidence-based and published from 2006 to 2011. (2) Five recommended medicines were included according to recommendations and evidence of WHOEML (2011), NEML (2009), CNF (2010) and other guidelines. They were metformin, glibenclamide, glipizide, rosiglitazone and pioglitazone. Domestic evidence of the first three drugs was evaluated. (3) The first three have been marketed with the specifications and dosage forms corresponding to guidelines in China. The FBG cost-effectiveness ratios of metformin with different dosage forms as immediate release compressed tablet, enteric-coated tablet and sustained release capsule were 3.37, 3.76 and 3.50 respectively. 2-hour BG cost-effectiveness ratios of metformin were 3.74, 4.00 and 3.71 respectively. The cost-effectiveness ratio of glibenclamide and glimepiride were 11.23 and 13.81 respectively.
Conclusion 　We offer a recommendation for: (1) Metformin (immediate release tablet/capsule for oral use, 0.25 g), contraindicated in patients with renal insufficiency. (2) Glibenclamide (tablet, 2.5 mg; capsule, 1.75 mg) and glipizide (tablet, 2.5 or 5mg; dispersible tablet, 5 mg), contraindicated in children, women during pregnancy or lactation, patients in the perioperative period of major operation, patients after total pancreatectomy, and patients allergic or adversely reacted to sulfa drug. (3) Evidence-based and standardized primary healthcare guidelines as well as clinical and pharmacoeconomic studies on diabetes mellitus (large-scale, multi-centre, randomized and double-blinded) are needed to produce high-quality local evidence.

Citation： LI Xiao,YANG Zongxia,LI Youping,LI Honghao,SHEN Jiantong,WANG Li,YANG Xiaoyan,LI Cuicui,WANG Yingqiang. Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 19. Diabetes Mellitus. Chinese Journal of Evidence-Based Medicine, 2012, 12(8): 1017-1023. doi: 10.7507/1672-2531.20120158 Copy

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22.	朱才娟, 陶霞, 邓渝林, 等. 4种口服降糖药治疗糖尿病的成本－效果分析. 中国药房, 2004, 15(1): 32-33.
23.	贾洁. 社区医院在慢病管理—糖尿病治疗上的优势. 中国社区医师, 2008, 24(18): 11-12.
24.	苏娜, 徐珽, 唐尧. 二甲双胍致不良反应的文献分析. 华西医学, 2011, 26(11): 1608-1610.

1. 叶任高, 陆再英, 谢毅, 等主编. 内科学. 第6版. 北京: 人民卫生出版社, 2004: 787-808.
2. 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2010年版). 中国医学前沿杂志(电子版), 2011, 3(6): 54-108.
3. 李鸿浩, 王应强, 李幼平, 等. 循证评价与遴选中国东中西部乡院基本药物系列之一: 我国东中西部8家示范乡院2010年住院疾病构成分析. 中国循证医学杂志, 2012(3): 260-266.
4. 李鸿浩, 李幼平, 王莉, 等. 循证评价与遴选东中西部乡院基本药物系列之二: 评价标准、方法与流程研究. 循证医学杂志, 2012, 12(3): 347-356.
5. The Clinical & Scientific Section of the Canadian Diabetes Association. Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Canadian Journal of Diabetes, 2009, 52: 552-553.
6. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice. Medical guidelines for clinical practice foe developing a diabetes mellitus comprehensive care plan. AACE Diabetes Care Plan Guidelines. Endocr Pract, 2011, 17(SUPPL2): 1-53.
7. Scottish Intercollegiate Guidelines Network (SIGN). Management of diabetes A national clinical guideline.2011. Available at: http://www.sign.ac.uk.
8. SEMDSA. SEMDSA Guidelines for Diagnosis and Management of Type 2 Diabetes Mellitus for Primary Health Care-2009. Available at: http://www.semdsa.org.za/.
9. WHO. Guidelines for the prevention, management and care of diabetes mellitus. 2006. Available at: http://www.who.int/zh/.
10. WHO Model List of Essential Medicines (17th list). 2011. Available at: http://www.who.int/medicines/publications/essentialmedicines/en/index.html.
11. 国家基本药物目录化学药品和生物制品(2009版基层部分). 人民卫生出版社, 2009.
12. Stuart MC, Kouimtzi M, Hill SR. WHO model formulary 2008.
13. 中国国家处方集. 化学药品与生物制品卷. 人民军医出版社, 2010.
14. 何嗣英, 吴勇群. 二甲双胍和格列吡嗪对胰岛素敏感指数等的影响. 海南医学院学报, 2006, 12(4): 336-337.
15. 戴浩. 二甲双胍与优降糖对2型糖尿病患者胰岛素敏感性的作用比较. 泸州医学院学报, 2001, 24(4): 305-306.
16. 胡绍勤, 吴卫娟, 李素婷, 等. 二甲双胍与诺和灵30R联合治疗2型糖尿病的临床研究. 中国医药指南, 2010, 8(8): 123-124.
17. 余健华, 姚惠芬, 何文静. 不同剂型二甲双胍治疗2型糖尿病的对比分析. 实用医学杂志, 2008, 24(23): 4112-4113.
18. 中华人民共和国国家发展和改革委员会.国家发展改革委关于公布国家基本药物零售指导价格的通知. Available at: http://www.sdpc.gov.cn/zcfb/zcfbtz/2009tz/t20091002_305945.htm.
19. 中华人民共和国国家发展和改革委员会. 国家发展改革委关于制定吡喹酮等260种药品最高零售价格的通知. Available at: http://www.sdpc.gov.cn/zfdj/jggg/yaopin/t20070509_134187.htm.
20. 贾贺, 韩萍. 格列美脲与格列苯脲治疗2型糖尿病Meta分析. 中国实用内科杂志, 2011, 31(11): 862-864.
21. 魏建春,阮丹杰,孟小征, 等. 列吡嗪对2型糖尿病患者血糖血脂的影响. 现代生物医学进展, 2010, 10(16): 3067-3069.
22. 朱才娟, 陶霞, 邓渝林, 等. 4种口服降糖药治疗糖尿病的成本－效果分析. 中国药房, 2004, 15(1): 32-33.
23. 贾洁. 社区医院在慢病管理—糖尿病治疗上的优势. 中国社区医师, 2008, 24(18): 11-12.
24. 苏娜, 徐珽, 唐尧. 二甲双胍致不良反应的文献分析. 华西医学, 2011, 26(11): 1608-1610.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 19. Diabetes Mellitus

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