Department of Clinical Biochemistry, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Diabetes Res Clin Pract. 2011 Nov;94(2):284-90. doi: 10.1016/j.diabres.2011.07.028. Epub 2011 Aug 21.
We aimed to determine the associations between metformin or sulphonylurea monotherapy at study entry into the FIELD diabetes trial and (1) metabolic risk factors, (2) risk of a first major cardiovascular (CVD) outcome, and (3) the effect of each therapy on the risk-modifying effect of fenofibrate.
Patients receiving metformin or sulphonylureas without insulin therapy were compared for the relative risk of CVD outcomes, adjusted for differences in baseline characteristics likely to affect risk.
Metformin-treated patients were likely to be younger, female, or obese. Metformin was associated with higher levels of lipids (other than LDL-C) and homocysteine (P<0.001). Sulphonylurea-treated patients had a longer history of diabetes and more CVD and microvascular disease. Sulphonylurea treatment was associated with higher plasma creatinine and lower plasma HDL-C (P<0.001). The risks of all CVD outcomes were higher for those on sulphonylureas than diet alone, but were nonsignificant after adjustment for the duration and intensity of diabetes and severity of risk factors. Metformin and sulphonylureas did not significantly influence the benefits of fenofibrate on CVD outcomes.
Apparent differences in the risk of CVD outcomes associated with oral hypoglycemics therapy were largely abolished by adjustment for diabetes and CVD risk factors.
我们旨在确定 FIELD 糖尿病试验中研究开始时二甲双胍或磺酰脲类单药治疗与（1）代谢危险因素，（2）首次主要心血管（CVD）结局风险，以及（3）每种治疗对非诺贝特的风险修正作用的相关性。
比较接受二甲双胍或磺酰脲类药物而无胰岛素治疗的患者，以调整可能影响风险的基线特征差异。
二甲双胍治疗的患者可能更年轻、女性或肥胖。二甲双胍与更高水平的脂质（除 LDL-C 外）和同型半胱氨酸有关（P<0.001）。磺酰脲类治疗的患者糖尿病史更长，且有更多的 CVD 和微血管疾病。磺酰脲类治疗与更高的血浆肌酐和更低的血浆高密度脂蛋白胆固醇（P<0.001）有关。磺酰脲类治疗的所有 CVD 结局风险均高于饮食治疗，但调整糖尿病和 CVD 风险因素的持续时间和强度以及严重程度后无统计学意义。二甲双胍和磺酰脲类药物对非诺贝特治疗 CVD 结局的获益无显著影响。
与口服降糖药治疗相关的 CVD 结局风险的明显差异，通过调整糖尿病和 CVD 风险因素后基本消除。
