The University of Texas at Austin College of Pharmacy, Austin, Texas 78712-0127, USA.
Clin Ther. 2011 Dec;33(12):2016-20. doi: 10.1016/j.clinthera.2011.10.018. Epub 2011 Nov 21.
Patients newly diagnosed with type 2 diabetes mellitus generally initiate therapy with either metformin [Met] or a sulfonylurea [SU] drug, followed by the addition of a second agent (Met, an SU drug, or a thiazolidinedione [TZD] drug) if the diabetes is not well controlled. If necessary, the usual third line of treatment is the addition of insulin.
The purpose of our study was to compare the progression to insulin among 3 cohorts receiving the oral antidiabetic (OAD) drug combinations Met/SU, Met/TZD, or SU/TZD.
This study used data from the Texas Medicaid database. The date of addition of a second OAD was considered a patient's index date and patients were followed for up to 5 years. Cox proportional hazards regression compared the progression to first insulin use among cohorts, using the Met/SU cohort as the reference group, while adjusting for demographics, comorbidities, and propensity scores.
A total of 4083 patients were included in the study (Met/SU = 2872, Met/TZD = 438, and SU/TZD = 773). Insulin was added to the medication regimen of patients by the end of follow-up in 19.7% of the Met/SU cohort, 17.6% of the Met/TZD cohort, and 26.3% of the SU/TZD cohort. The adjusted Cox proportional model estimated that patients in the SU/TZD cohort had a 40% higher probability of progression to insulin than patients in the Met/SU cohort (odds ratio [OR] = 1.40; 95% CI, 1.19-1.64), whereas there was no significant difference between the Met/TZD and Met/SU cohorts (OR = 0.85; 95% CI, 0.67-1.08).
It appears that mechanism of action may play a role in progression to insulin for concomitant OAD agents. A slower progression to insulin was seen for patients receiving a paired sensitizer regimen (ie, Met/TZD) compared with those receiving a secretagogue sensitizer regimen (ie, SU/TZD).
新诊断为 2 型糖尿病的患者通常起始治疗药物为二甲双胍[Met]或磺酰脲类[SU]药物，如果血糖控制不佳，则添加第二种药物（Met、SU 类药物或噻唑烷二酮[TZD]类药物）。如果需要，通常的三线治疗是添加胰岛素。
我们的研究目的是比较接受口服抗糖尿病药物（OAD）联合治疗 Met/SU、Met/TZD 或 SU/TZD 的 3 个队列进展为胰岛素的情况。
本研究使用了德克萨斯州医疗补助数据库的数据。添加第二种 OAD 的日期被视为患者的索引日期，并对患者进行了长达 5 年的随访。Cox 比例风险回归比较了队列之间进展为首次使用胰岛素的情况，以 Met/SU 队列作为参考组，同时调整了人口统计学、合并症和倾向评分。
共有 4083 名患者纳入研究（Met/SU=2872，Met/TZD=438，SU/TZD=773）。在随访结束时，Met/SU 队列中有 19.7%、Met/TZD 队列中有 17.6%和 SU/TZD 队列中有 26.3%的患者在药物治疗方案中添加了胰岛素。调整后的 Cox 比例模型估计，SU/TZD 队列的患者进展为胰岛素的可能性比 Met/SU 队列的患者高 40%（优势比[OR]=1.40；95%CI，1.19-1.64），而 Met/TZD 队列与 Met/SU 队列之间没有显著差异（OR=0.85；95%CI，0.67-1.08）。
作用机制似乎在 OAD 联合药物进展为胰岛素方面发挥作用。与接受促分泌素敏化剂治疗方案（即 SU/TZD）的患者相比，接受联合敏化剂治疗方案（即 Met/TZD）的患者进展为胰岛素的速度较慢。
