Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Pharmacoepidemiol Drug Saf. 2010 Nov;19(11):1108-12. doi: 10.1002/pds.2035.
Systematic reviews have reported that sulfonylureas and metformin were as effective in reducing hemoglobin A1c (A1C) as other oral antidiabetic drugs (OADs) in clinical trial populations. Data on comparative effectiveness of OADs in other populations is limited. The objective was to compare the effectiveness of incident OAD regimens in reducing A1C and to compare the effect of OADs on body mass index (BMI).
Retrospective cohort study using data from the Veterans Affairs Mid-South network (2001-2007). Of 18 205 veterans who filled 19 511 incident OAD prescriptions, 2096 had complete covariates, persisted on their incident treatment for 12 months, and had baseline and 12-month A1C values. For the BMI analysis, 2484 patients had complete information. Incident OAD regimens included metformin and sulfonylureas. Primary outcomes were 12-month A1C and BMI, which were compared controlling for demographic characteristics, baseline A1C and BMI, psychiatric diagnoses, and healthcare utilization.
Median [interquartile range (IQR)] A1C decreased from 7.1% [6.5, 7.8] at baseline to 6.5% [6.0, 7.0] at 12 months. Twelve month-A1C in sulfonylurea users was similar to metformin users. The median [IQR] BMI decreased from 31.1 [27.8, 34.9] to 30.7 [27.5, 34.5] kg/m(2). Sulfonylureas were associated with a significantly higher 12-month BMI than metformin (12-month adjusted mean difference: 1.05 kg/m(2), 95%CI: 0.90-1.20, p < 0.0001).
These analyses support the use of metformin as first choice of OAD because of similar glycemic control but improved BMI when compared to sulfonylureas.
系统评价报告称，磺酰脲类药物和二甲双胍在临床试验人群中的降血红蛋白 A1c（A1C）效果与其他口服降糖药（OAD）相当。关于其他人群中 OAD 比较效果的数据有限。本研究旨在比较 OAD 方案在降低 A1C 方面的有效性，并比较 OAD 对体重指数（BMI）的影响。
使用退伍军人事务部中南部网络（2001-2007 年）的数据进行回顾性队列研究。在 18205 名服用 19511 种 OAD 处方的退伍军人中，有 2096 名患者具有完整的协变量，持续接受他们的起始治疗 12 个月，并具有基线和 12 个月 A1C 值。对于 BMI 分析，有 2484 名患者具有完整信息。起始 OAD 方案包括二甲双胍和磺酰脲类药物。主要结局为 12 个月 A1C 和 BMI，通过控制人口统计学特征、基线 A1C 和 BMI、精神科诊断和医疗保健利用来比较。
中位数[四分位距（IQR）]A1C 从基线时的 7.1%[6.5，7.8]下降到 12 个月时的 6.5%[6.0，7.0]。磺酰脲类药物使用者的 12 个月 A1C 与二甲双胍使用者相似。中位数[IQR]BMI 从 31.1[27.8，34.9]kg/m2下降到 30.7[27.5，34.5]kg/m2。与二甲双胍相比，磺酰脲类药物治疗 12 个月后 BMI 显著升高（12 个月调整后平均差值：1.05kg/m2，95%CI：0.90-1.20，p<0.0001）。
这些分析支持将二甲双胍作为 OAD 的首选药物，因为与磺酰脲类药物相比，其在血糖控制方面相似，但 BMI 改善。
