Kahler Kristijan H, Rajan Mangala, Rhoads George G, Safford Monika M, Demissie Kitaw, Lu Shou-En, Pogach Leonard M
Center for Health Care Knowledge and Management, VA New Jersey Health Care System, East Orange, New Jersey, USA.
Diabetes Care. 2007 Jul;30(7):1689-93. doi: 10.2337/dc06-2272. Epub 2007 Apr 17.
The objective of this analysis was to evaluate the impact of several classes of oral antihyperglycemic therapy relative to sulfonylurea monotherapy on all-cause mortality among a cohort of patients with diabetes from the Veterans Health Administration (VHA).
A retrospective cohort study using data obtained from the VHA Diabetes Epidemiology Cohort was used. Users of oral antihyperglycemic therapy were classified into the following cohorts: sulfonylurea monotherapy, metformin monotherapy, metformin plus sulfonylurea, thiazolidinedione (TZD) use alone or in combination with other oral agents (TZD users), and no drug therapy. All-cause mortality was the outcome of interest. Multivariate mixed models incorporating a propensity score to account for imbalance among cohorts were used to estimate drug effects on mortality with associated 95% CIs.
A total of 39,721 patients with diabetes were included in the study. Adjusted odds ratios and 95% CIs for all-cause mortality were 0.87 (0.68-1.10) for metformin monotherapy users, 0.92 (0.82-1.05) for metformin plus sulfonylurea users, and 1.04 (0.75-1.46) for TZD users, relative to sulfonylurea monotherapy users.
We did not find any significant drug effect on all-cause mortality for any oral treatment cohorts relative to sulfonylurea oral monotherapy.
本分析的目的是评估退伍军人健康管理局（VHA）中一组糖尿病患者使用几类口服降糖疗法相对于磺脲类单药治疗对全因死亡率的影响。
采用一项回顾性队列研究，使用从VHA糖尿病流行病学队列中获得的数据。口服降糖疗法使用者被分为以下队列：磺脲类单药治疗、二甲双胍单药治疗、二甲双胍加磺脲类、噻唑烷二酮（TZD）单独使用或与其他口服药物联合使用（TZD使用者），以及未进行药物治疗。全因死亡率是感兴趣的结局。使用纳入倾向评分以解释队列间不平衡的多变量混合模型来估计药物对死亡率的影响及相关的95%置信区间。
该研究共纳入39,721例糖尿病患者。相对于磺脲类单药治疗使用者，二甲双胍单药治疗使用者全因死亡率的调整比值比及95%置信区间为0.87（0.68 - 1.10），二甲双胍加磺脲类使用者为0.92（0.82 - 1.05），TZD使用者为1.04（0.75 - 1.46）。
相对于磺脲类口服单药治疗，我们未发现任何口服治疗队列对全因死亡率有显著的药物影响。
