Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Diabetes Care. 2010 Jun;33(6):1224-9. doi: 10.2337/dc10-0017. Epub 2010 Mar 9.
Sulfonylureas have historically been analyzed as a medication class, which may be inappropriate given the differences in properties inherent to the individual sulfonylureas (hypoglycemic risk, sulfonylurea receptor selectivity, and effects on myocardial ischemic preconditioning). The purpose of this study was to assess the relationship of individual sulfonylureas and the risk of overall mortality in a large cohort of patients with type 2 diabetes.
A retrospective cohort study was conducted using an academic health center enterprise-wide electronic health record (EHR) system to identify 11,141 patients with type 2 diabetes (4,279 initiators of monotherapy with glyburide, 4,325 initiators of monotherapy with glipizide, and 2,537 initiators of monotherapy with glimepiride), >or=18 years of age with and without a history of coronary artery disease (CAD) and not on insulin or a noninsulin injectable at baseline. The patients were followed for mortality by documentation in the EHR and Social Security Death Index. Multivariable Cox models were used to compare cohorts.
No statistically significant difference in the risk of overall mortality was observed among these agents in the entire cohort, but we did find evidence of a trend toward an increased overall mortality risk with glyburide versus glimepiride (hazard ratio 1.36 [95% CI 0.96-1.91]) and glipizide versus glimepiride (1.39 [0.99-1.96]) in those with documented CAD.
Our results did not identify an increased mortality risk among the individual sulfonylureas but did suggest that glimepiride may be the preferred sulfonylurea in those with underlying CAD.
磺酰脲类药物在历史上一直被作为一类药物进行分析，但鉴于个体磺酰脲类药物（低血糖风险、磺酰脲受体选择性和对心肌缺血预处理的影响）固有的性质差异，这种分析方法可能并不合适。本研究旨在评估个体磺酰脲类药物与 2 型糖尿病大患者队列整体死亡率之间的关系。
本回顾性队列研究使用学术医疗中心全企业范围的电子健康记录（EHR）系统进行，以确定 11,141 名 2 型糖尿病患者（4,279 名格列吡嗪单药治疗的起始者，4,325 名格列美脲单药治疗的起始者，和 2,537 名格列本脲单药治疗的起始者），年龄均>18 岁，且无论基线时是否患有冠心病（CAD）以及是否正在使用胰岛素或非胰岛素注射剂。通过 EHR 和社会安全死亡索引中的记录来对患者进行死亡率随访。采用多变量 Cox 模型来比较队列。
在整个队列中，这些药物之间在整体死亡率风险方面没有统计学上的显著差异，但我们确实发现了一些证据表明，与格列美脲相比，格列本脲与格列吡嗪（危险比 1.36 [95%CI 0.96-1.91]）和格列吡嗪（1.39 [0.99-1.96]）在有记录 CAD 的患者中，整体死亡率风险增加的趋势。
我们的结果并未确定个体磺酰脲类药物会增加死亡率风险，但确实表明对于患有潜在 CAD 的患者，格列美脲可能是首选的磺酰脲类药物。
