Department of Preventive Medicine, Seoul National University College of Medicine, Korea.
Pharmacoepidemiol Drug Saf. 2011 Apr;20(4):344-50. doi: 10.1002/pds.2112. Epub 2011 Feb 17.
To compare the prescribing patterns of thiazolidinediones (TZDs) in elderly patients with type 2 diabetes with and without heart failure (HF).
The national health insurance claims database from the Health Insurance Review & Assessment Service (HIRA), Korea was used. Elderly patients with type 2 diabetes taking at least one hypoglycemic agent were studied between July 1, 2005 and June 30, 2006. Patients were grouped according to the presence of HF. The proportion of patients receiving TZDs were compared between the two groups, and stratified by their diabetes medication regimen (monotherapy and combination therapy). The difference in the patterns of TZD prescribed was studied across all health care levels including: primary, secondary, and tertiary care facilities.
Among 357,855 elderly patients with type 2 diabetes, 24,746 patients had HF. TZDs were prescribed to 10.4% of the patients with HF and 8.8% of the patients without HF (p < 0.01). In the combination therapy group, the proportion of patients receiving TZDs was 17.9% and 14.4% in patients with and without HF, respectively (p < 0.01). In the primary care setting, the proportion of TZD prescriptions in patients with HF was 5.6% and it was 4.6% in patients without HF (p < 0.01).
TZDs were frequently prescribed to patients with HF, even though the TZDs were contraindicated in patients with HF. Health care professionals should consider alternative therapies for patients with type 2 diabetes mellitus. In addition, they should carefully monitor the impact of TZD use in patients with HF.
比较伴有和不伴有心力衰竭（HF）的 2 型糖尿病老年患者噻唑烷二酮（TZDs）的处方模式。
使用来自韩国健康保险审查与评估服务（HIRA）的国家健康保险索赔数据库。研究了 2005 年 7 月 1 日至 2006 年 6 月 30 日期间至少服用一种降糖药的 2 型糖尿病老年患者。根据是否存在 HF 将患者分组。比较两组患者接受 TZDs 的比例，并按其糖尿病药物治疗方案（单药治疗和联合治疗）进行分层。研究了所有医疗保健水平（包括初级、二级和三级保健设施）中 TZD 处方模式的差异。
在 357855 例 2 型糖尿病老年患者中，有 24746 例患者患有 HF。HF 患者中 TZDs 的处方率为 10.4%，无 HF 患者中为 8.8%（p<0.01）。在联合治疗组中，HF 患者中接受 TZDs 治疗的患者比例为 17.9%，无 HF 患者中为 14.4%（p<0.01）。在初级保健环境中，HF 患者中 TZD 处方的比例为 5.6%，无 HF 患者中为 4.6%（p<0.01）。
尽管 TZDs 禁用于 HF 患者，但仍经常为 HF 患者开具 TZDs。医疗保健专业人员应考虑为 2 型糖尿病患者选择替代疗法。此外，他们应仔细监测 HF 患者使用 TZD 的影响。
