Hospital Gregorio Marañón, Madrid, Spain.
Diabetes Res Clin Pract. 2011 Jan;91(1):108-14. doi: 10.1016/j.diabres.2010.10.002. Epub 2010 Oct 29.
Primary aim: to determine the degree of control of HbA(1c) at the time of treatment intensification (TI) in T2DM patients. Secondary aims: fasting plasma glucose levels; estimation of the elapsed time between HbA(1c) exceeding 7% and TI; antidiabetic combinations used, % patients with good cardiometabolic control (LDL-c<100mg/dL; SBP<130 and DPB<80mmHg and HbA(1c)<7%).
one-cohort, multicenter, retrospective, observational study conducted in Spain. Patients diagnosed with T2DM that had switched from monotherapy to combination antidiabetic therapy were evaluated at baseline and after one year of follow-up.
a total of 1202 T2DM patients were analyzed. At the time of TI: mean HbA(1c) 8.1%; median time of uncontrolled disease: 2.0 years. After one-year of TI: significant reduction in mean HbA(1c) (8.1% vs.7.0%, p<0.001) and a mean fasting plasma glucose levels reduction (181.1mg/dL vs.144.1mg/dL, p<0.001) was also observed. The percentage of patients under glycemic control (HbA(1c)<7%) increased from 12.2% to 51.6% (p<0.001). Most common antidiabetic combinations: metformin+sulfonylurea (44.1%) and metformin+thiazolidindione (15.9%).
in the population of T2DM patients analyzed, TI was carried out when HbA(1c) values were above those recommended in clinical guidelines (≤ 7%), with a delay of two years to address the second step of therapy, despite the consensus recommendation of the ADA/EASD of 3 months. TI was shown to be effective since addition of a second antidiabetic drug led to an average reduction of HbA(1c) of approximately 1%. Metformin was the drug most commonly used as monotherapy being the most frequent combination metformin+sulfonylurea.
主要目的：确定 2 型糖尿病（T2DM）患者强化治疗（TI）时 HbA1c 的控制程度。次要目的：空腹血糖水平；估计 HbA1c 超过 7%与 TI 之间的时间；使用的抗糖尿病联合用药，良好的心血管代谢控制的患者比例（LDL-c<100mg/dL；SBP<130mmHg 和 DBP<80mmHg 以及 HbA1c<7%）。
这是一项在西班牙进行的单队列、多中心、回顾性、观察性研究。评估了从单药治疗转换为联合抗糖尿病治疗的 T2DM 患者的基线和一年随访情况。
共分析了 1202 名 T2DM 患者。在 TI 时：平均 HbA1c 为 8.1%；未控制疾病的中位时间为 2.0 年。经过一年的 TI：平均 HbA1c（8.1% vs.7.0%，p<0.001）和平均空腹血糖水平显著降低（181.1mg/dL vs.144.1mg/dL，p<0.001）。血糖控制患者的比例（HbA1c<7%）从 12.2%增加到 51.6%（p<0.001）。最常见的抗糖尿病联合用药：二甲双胍+磺酰脲（44.1%）和二甲双胍+噻唑烷二酮（15.9%）。
在分析的 T2DM 患者人群中，HbA1c 值高于临床指南推荐的（≤7%）时进行 TI，延迟两年才开始治疗的第二步，尽管 ADA/EASD 共识建议为 3 个月。添加第二种抗糖尿病药物可使 HbA1c 平均降低约 1%，表明 TI 是有效的。二甲双胍是最常用的单药治疗药物，最常见的联合用药是二甲双胍+磺酰脲。
