Medical, VA Northern California Health Care System , Martinez, USA.
Metab Syndr Relat Disord. 2011 Dec;9(6):469-73. doi: 10.1089/met.2011.0038. Epub 2011 Aug 24.
The aim of this study was to evaluate long-term glycemic control in individuals with type 2 diabetes mellitus on oral hypoglycemic agents.
We identified the cohort of veterans prescribed hypoglycemic agents every year from July, 1992, through June, 2007 (n=191). Glycosylated hemoglobin (HbA1c) was used to assess glycemic control. Data are expressed as mean±standard deviation (SD); statistics are expressed by t-test and chi-squared. P<0.05 was considered significant.
In the first year, 96 of the select group of 191 veterans identified above received oral agents only (OAO), 74 insulin only, and 21 both insulin and oral agents. Fifteen years later, 59 were OAO, 78 insulin only, and 54 both. Six patients receiving insulin in 1992-1993 were OAO-treated in 2006-2007. In the subgroup on OAO both at baseline and at the end (n=53), HbA1c decreased from 7.89±1.21 to 7.09±1.13 (P<0.001). These veterans were older at baseline (62.4±6.2) and leaner at the 15-year follow-up [body mass index (BMI) 28.1±4.9] than those who received insulin in 2006-2007 (n=43; age=57.9±9.6; BMI=32.3±7.9; P<0.05 and 0.005, respectively). Patients in the stable OAO group (n=53) were 74.0% Caucasian, compared to 51.2% in former-OAO [n=43; P<0.05 (chi-squared)].
Over half (n=53; 55%) of patients originally in the OAO group remained so 15 years later. These stable patients were in better glycemic control, both at baseline and follow-up, less obese, older, and more likely to be Caucasian, than those who eventually received insulin. Currently used oral agents often maintain, or even improve, glucose control, over 2 decades after diagnosis of diabetes mellitus.
本研究旨在评估口服降糖药物治疗 2 型糖尿病患者的长期血糖控制情况。
我们确定了 1992 年 7 月至 2007 年 6 月期间每年服用降糖药物的退伍军人队列（n=191）。糖化血红蛋白（HbA1c）用于评估血糖控制情况。数据表示为均数±标准差（SD）；统计数据表示为 t 检验和卡方检验。P<0.05 被认为具有统计学意义。
在最初的 191 名退伍军人中，有 96 人仅接受口服药物治疗（OAO），74 人仅接受胰岛素治疗，21 人同时接受胰岛素和口服药物治疗。15 年后，59 人仅接受 OAO 治疗，78 人仅接受胰岛素治疗，54 人同时接受两种治疗。1992-1993 年接受胰岛素治疗的 6 名患者在 2006-2007 年接受 OAO 治疗。在基线和结束时均接受 OAO 治疗的亚组（n=53）中，HbA1c 从 7.89±1.21 降至 7.09±1.13（P<0.001）。这些退伍军人在基线时年龄较大（62.4±6.2），在 15 年随访时体重指数（BMI）较低[28.1±4.9]，而在 2006-2007 年接受胰岛素治疗的患者（n=43；年龄=57.9±9.6；BMI=32.3±7.9；P<0.05 和 0.005）。在稳定的 OAO 组（n=53）中，74.0%为白种人，而前 OAO 组（n=43）为 51.2%；P<0.05（卡方检验）。
超过一半（n=53；55%）的初始 OAO 组患者在 15 年后仍保持该治疗方案。这些稳定的患者在基线和随访时的血糖控制更好，体重指数更低，年龄更大，更有可能是白种人，而不是最终接受胰岛素治疗的患者。在糖尿病诊断后 20 多年，目前使用的口服药物通常可以维持甚至改善血糖控制。
