Yee A, Majumdar S R, Simpson S H, McAlister F A, Tsuyuki R T, Johnson J A
Department of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.
Diabet Med. 2004 Sep;21(9):962-7. doi: 10.1111/j.1464-5491.2004.01263.x.
It has been suggested that HMG Co-A reductase inhibitors ('statins') may reduce the risk of developing Type 2 diabetes mellitus. This study was designed to evaluate whether use of statins would also delay progression to insulin therapy.
This was a retrospective cohort study using Saskatchewan Health databases to identify subjects newly started on oral antidiabetic agents from 1991 to 1996.
< 30 years of age or with previous lipid-lowering drug use were excluded. Medications known to influence glycaemic control, co-morbidity, and demographic data were collected. Statin exposure was defined as at least 1 year of use. Primary outcome was starting insulin treatment. Multivariate Cox proportional hazards models were used to examine the association between statin use and starting insulin.
The final cohort included 10,996 new users of oral antidiabetic agents, of which 484 (4.4%) used statins. Mean age was 64 years and 55% were male. Mean duration of follow-up was 5.1 years; 11.1% (n = 1221) eventually started insulin treatment. Statin users were no less likely than non-users to start insulin treatment eventually (11.6% vs. 11.1%, P = 0.74). After multivariate adjustment, however, statin use was associated with a 10-month delay before newly treated diabetic subjects needed to start insulin treatment (adjusted hazard ratio 0.74; 95% confidence interval 0.56, 0.97, P = 0.028).
The use of statins is associated with a delay in starting insulin treatment in patients with Type 2 diabetes initially treated with oral antidiabetic agents. Whether this relationship exists for patients at high risk of developing diabetes should be examined in a randomized trial.
有人提出，HMG辅酶A还原酶抑制剂（“他汀类药物”）可能降低患2型糖尿病的风险。本研究旨在评估使用他汀类药物是否也会延缓胰岛素治疗的进程。
这是一项回顾性队列研究，利用萨斯喀彻温省卫生数据库识别1991年至1996年新开始使用口服抗糖尿病药物的受试者。
排除年龄小于30岁或既往使用过降脂药物的人。收集已知会影响血糖控制、合并症和人口统计学数据的药物。他汀类药物暴露定义为使用至少1年。主要结局是开始胰岛素治疗。采用多变量Cox比例风险模型来检验他汀类药物使用与开始胰岛素治疗之间的关联。
最终队列包括10996名口服抗糖尿病药物的新使用者，其中484人（4.4%）使用他汀类药物。平均年龄为64岁，55%为男性。平均随访时间为5.1年；11.1%（n = 1221）最终开始胰岛素治疗。他汀类药物使用者最终开始胰岛素治疗的可能性并不低于非使用者（11.6%对11.1%，P = 0.74）。然而，经过多变量调整后，他汀类药物的使用与新治疗的糖尿病患者开始胰岛素治疗前延迟10个月相关（调整后风险比0.74；95%置信区间0.56, 0.97，P = 0.028）。
对于最初接受口服抗糖尿病药物治疗的2型糖尿病患者，使用他汀类药物与开始胰岛素治疗的延迟有关。这种关系在糖尿病高危患者中是否存在，应在一项随机试验中进行研究。
