| 摘要: | 背景：民國103年在臺灣十大死因排行中糖尿病排名第五位，臺灣第2型糖尿病人有增
加趨勢，糖尿病造成併發症(大、小血管併發症)是受人矚目且造成昂的醫療支出
，傳統中醫學已有數千年歷史，台灣民眾使用中藥產品呈現快速增加。在台灣民
眾對替代療法接受度也很高，調查 6年時間內(1996-2001)有60％以上民眾曾經
使用中藥，糖尿病人施行輔助和替代醫學療法的意願是正常人的 1.6 倍。糖尿
病人中西藥併服時，會增加使用藥品的複雜性，甚至導致低血糖藥物交互作用的
風險。
方法：本研究是回溯性收集與評估民國101-103年至個案醫院門診就診民眾，90天內曾
在個案醫院診斷為糖尿病（ICD-9-CM碼為250.02、250.03）且至少就醫達2次
(含)以上之病人，半年有接受2次HbA1c抽血以上且 HbA1c≧6.5%，排除年齡
未滿20歲糖尿病人、沒併用中西藥物案例，收案個案做實體病歷回顧。分析中
西藥併用病人特性，併用後是否有增加治療效果或有潛在低血糖藥物交互作用風
險。
結果：本研究回溯民國101-103年間資料共計收案124位病人，3年間平均有13.1%
病人採用中西藥併用，平均年齡67.7歲（SD:11.4），男性佔41.9%；平均每
位病人罹患3.6個疾病（SD: 1.5）。西藥方面每人平均使用9.2種藥品（SD:
8.6），中藥方面使用136種複方與138種單方，最常使用單方中藥藥品種類遠
志、丹參、天花粉，複方品項用人次排序前三名為白虎加人參湯,血府逐瘀湯,
溫膽湯。無論用國內政府機關已架網站搜索結果47個案(37.9%)或以學術文獻篩
選結果45個案(36.3%)中西藥併用有潛在會造成低血糖藥物交互作用。124位收
案病人體重由平均65.9公斤（SD: 12.8），收案9個月後病人體重平均降為
64.4公斤（SD: 11.8），糖化血色素由平均8.9%（SD: 1.6）收9個月後平均降
為8.6%（SD: 1.5）。有關糖化血色素的高低與其改善的相關性以 Mantel-
Haenszel Chi-Square作分析，訂定p < 0.05具統計學上的差異(p < 0.0001)。
結論：個案醫院使用中西藥併用病人數3年間平均13.1%與全國性調查相仿，中西藥併
用病人性別女性人數比男人數性多，年齡層以60-69歲人數最多。HbA1C抽血報告
有2次降低紀錄病人有55.7%。同期(101-103年)個案醫院診有2次降低紀錄病
人有 353位(41.0%)，顯示病人接受中西藥併用比只接受西藥治療之糖化血色素
改善的勝算比 (OR)是1.36。
Background: In 2012, diabetes ranked 5th in the 10 most common causes of death in Taiwan with and increasing trend of incidence of type 2 diabetes. Complications caused by diabetes is one of the subjects of attention that reflects into increased medical expenses. Traditional Chinese medicine has a very old history and its use has dramatically increased in Taiwan. There is a high acceptance of alternative therapies by Taiwanese citizens, a 6 year survey from 1996 – 2001 shows that more than 60% of the population had used Chinese medicine, and the willingness to complementary or alternative use of Chinese medicine is 1.6% than normal. Diabetic patients, when consuming both Chinese and Western medicine can raise the complexity of drug usage and can also lead to drug interactions.
Methods: This is a retrospective study using hospitals’ outpatient records from 2012-2014. The study group includes diabetic patients above the age of 20, with a diagnosis code (ICD-9-CM) of 250.02 or 250.03 within 90 days of the initial outpatient visit, having at least 2 outpatient visits, has underwent HbA1c test at least twice in 6 months, with HbA1c≥6.5% and excluding patients who has not used Chinese and Western Medicine in combination. The combined use of Chinese and Western Medicine to check the outcome of the combined medication and the potential risk of drug interaction was analyzed.
Results: A total of 124 patients from 2012-2014 was identified in this study, 13.1% patients used a combination of Chinese and Western medicine, average age of patient was 67.7 years (SD: 11.4), males accounted for 41.9%; patients were suffering from an average of 3.6 diseases (SD: 1.5). On an average, patients were consuming 9.2 types of Western medicine (SD: 8.6), 136 types of complex formula and 138 types of simple formula Chinese medicine. The most common simple formula Chinese medicine used are Polygalae Radix, Salviae Miltorrhizae Radix et Rhizoma and Trichosanthis Radix , and the 3 most common complex formula Chinese medicine used are Bai-hu-jia-ren-shen-tang, Xie-fu-zhu-yu-tang and Wen-dan-tang. There are 47 cases (37.9%) from online internet search and 45 paper (36.3%) from academic literature search using Chinese and Western medicine combination and drug interaction as the keywords. The initial average weight of 124 patients at the time of data collection was 65.9 kg (SD: 12.8) and 9 months later it was 64.4 kg (SD: 11.8), the initial average HbA1c was 8.9% (SD: 1.6) and 9 months later it was 8.6% (SD: 1.5). Haenszel Chi-Square was used to explore the factors relating to the blood levels of HbA1c and their improvement, p value of <0.05 was used for statistical significance (p <0.0001).
Conclusion: Similar to the data from nationwide survey, the patient case records from hospital shows an average of 13.1% of patients using Chinese and Western medicine in combination in a 3 year time period. The combination of Chinese and Western medicine are being used mostly by females and by patients between the age of 60-69 years. A reduction in HbA1C levels was observed in 55.7% of patients who had at least 2 HbA1C test. A lowering in HbA1C levels was observed twice in 353 patients (41.0%) over the 3 year study period. This demonstrates that patients who are using a combination of Chinese and Western medicine has an better impact on HbA1C levels than those who are only using Western medicine with an Odds Ratio of 1.36. |
