中醫門診糖尿病患者臨床用藥頻率與型態分析

Frequency and Pattern of Chinese Medicine Prescriptions Used to Treat Diabetes Mellitus Patients

目的：本研究以探討中醫師臨床治療糖尿病的用藥型態與頻率，醫療費用申報情況，單方及複方的用藥頻率，以探討逐年之醫療費用及提供中醫臨床治療糖尿病的一些資訊及期盼讓糖尿病的病者在治療糖尿病上的另一種有效的選擇為主要目的。材料與方法：本研究主要以中央健康保險局臺北業務組從2010－2011年中醫申報醫療費用的資料庫為掘取對象，以中醫臨床申報糖尿病相關疾病的ICD-9 250.0－250.9為掘取範圍。結果：2010年至2011年中醫門診所申報糖尿病人數與件數均有成長，2010年申報人數為11,570人，申報件數為60,197件，平均每人就醫次數為5.4次；而2011年申報人數為11,934人，申報件數為64,462件，平均每人就醫次數為5.4次。2010－2011年總人數為19,093人，總申報件數共計124,659件，平均每人就醫件數為6.5次。年齡層分佈，以46歲至75歲年齡層占最多，而其高峰層為56歲至65歲之間之中老年人居多。其男女患病之比率為48.12：51.88，呈現女多於男的現象。在治療方式件數上，以純內科的治療方法件數占93.77%為最多。糖尿病同病患歸戶歷年持續就醫追蹤38.12%。結論：本研究發現，臨床門診中醫治療糖尿病常用的單味中藥及複方中藥方劑主要的作用機轉不外乎滋陰、補陽、養肝補腎、生津益氣、活血化瘀、疏肝理氣為主，其中以調治腎之陰陽最為普遍，顯示看中醫的糖尿病病者以中老年肝腎失調的階段最多，由此可推論，這些病者的病程較久，可能因糖尿病已併發腎臟病的中後期階段，本研究結果可以提供臨床中醫師在治療糖尿病腎病的一個選擇。對於提昇中醫醫療品質應是正面的，並且讓糖尿病患者除西藥治療外，中醫臨床常用方藥對於糖尿病及其併發症的治療能提供一項有效的選擇。

Objectives: The aim of this study was to analyze the prescription frequency and pattern of traditional Chinese medicine (TCM) used to treat diabetic patients.Methods: We obtained the database of TCM outpatient (including ICD-9-250.0-250.90 claims from the National Health Insurance in Taipei for the whole 2010-2011. Patients with diabetic diseases were identified by the corresponding diagnosis of International Classification of Disease among claimed visiting files. Corresponding prescription files were analyzed and association rule were applied to evaluate the coprescription of TCM in treating diabetic diseases. We analysed the age distribution, prescription frequency and patterns of TCMs used to treat diabetic patients.Results: The number of people with diabetes treated with TCMs has increased from 2010 to 2011. We analyzed the age distribution, prescription frequency and pattern of TCMs used to treat diabetic patients among the 11570 subjects, 60197 formula in 2010 and 11934 subjects, 64462 formulain 2011. The age distribution was mainly between 46 to 75 years old both in men and women. The male-female ratio is 48.12:51.88. Women outnumbered men in seeking medical treatment.Conclusions: This study showed that the treatment of diabetes with Chinese herbs was based on the mechanisms, including nourishing yin, tonifying yang, tonifying kidney and nourishing liver, supplementing qi and promoting the production of body fluid, promoting blood circulation for removing blood stasis, and dispersing stagnated liver qi, especially common in moderating kidney yin and yang.We can demonstrate that the reason why the middle-aged and elderly patients seek TCM treatment for liver-kidney imbalance is possibly because diabetes mellitus may progress to the final or end-stage resulting in kidney disease. This study can not only provide another treatment option to TCM practitioners, but also help people with diabetes to perform effective management.