Division of Clinical Epidemiology, SMBD-Jewish General Hospital, Montreal, Quebec, Canada.
Pharmacoepidemiol Drug Saf. 2010 Apr;19(4):335-42. doi: 10.1002/pds.1834.
To determine whether combination of sulfonylureas and metformin increases the risk of death from any cause in patients with type 2 diabetes.
A nested case-control study was conducted within a population-based cohort from the UK General Practice Research Database (GPRD). The cohort included patients over the age of 40 who were prescribed a first oral hypoglycaemic agent between 1 January 1988 and 30 June 2008. Cases included all patients who deceased during follow-up. Up to 10 controls were matched to each case on year of birth, date of cohort entry (+/-1 year) and duration of follow-up. Conditional logistic regression was used to estimate rate ratios (RRs) of death from any cause associated with the use of combination of sulfonylureas and metformin, relative to sulfonylurea monotherapy.
The cohort comprised 84 231 users of oral hypoglycaemic agents, of whom 14 996 died from any cause during a mean of 4.3 years of follow-up (mortality rate 4.1 per 100 per year). Patients currently exposed to a combination of sulfonylureas and metformin were at a decreased risk of death from any cause compared to patients exposed to sulfonylurea monotherapy (adjusted RR: 0.77, 95%CI: 0.70, 0.85). Similar results were obtained for patients currently exposed to metformin monotherapy (adjusted RR: 0.70, 95%CI: 0.64, 0.75) when compared to sulfonylurea monotherapy. Patients had to be exposed to the combination therapy for at least 4 months prior to index date to experience a lower risk of mortality compared to sulfonylurea monotherapy.
The combination of sulfonylureas and metformin does not increase the risk of death. In contrast, it may moderately reduce this risk compared to sulfonylurea monotherapy.
确定在 2 型糖尿病患者中，磺酰脲类药物和二甲双胍联合使用是否会增加任何原因导致的死亡风险。
在英国全科医生研究数据库（GPRD）的基于人群的队列中进行了巢式病例对照研究。该队列包括年龄在 40 岁以上的患者，他们在 1988 年 1 月 1 日至 2008 年 6 月 30 日期间首次服用了一种口服降糖药。病例包括所有在随访期间死亡的患者。每个病例最多匹配 10 个对照，按出生年份、队列进入日期（±1 年）和随访时间匹配。采用条件逻辑回归估计与磺酰脲类药物单药治疗相比，联合使用磺酰脲类药物和二甲双胍与任何原因导致的死亡相关的死亡率比（RR）。
该队列包括 84231 名口服降糖药使用者，在平均 4.3 年的随访期间，有 14996 人死于任何原因（死亡率为每年每 100 人 4.1 人）。与磺酰脲类药物单药治疗相比，目前同时使用磺酰脲类药物和二甲双胍的患者死于任何原因的风险降低（调整后的 RR：0.77，95%CI：0.70，0.85）。与磺酰脲类药物单药治疗相比，目前同时使用二甲双胍的患者也得到了类似的结果（调整后的 RR：0.70，95%CI：0.64，0.75）。与磺酰脲类药物单药治疗相比，患者必须在指数日期前至少接受联合治疗 4 个月才能降低死亡率风险。
磺酰脲类药物和二甲双胍联合使用不会增加死亡风险。相反，与磺酰脲类药物单药治疗相比，它可能会适度降低这种风险。
