Endocrinology, Summa Western Reserve Hospital Physicians, Inc., Hudson, OH 44236, USA.
Diabet Med. 2012 Aug;29(8):1029-35. doi: 10.1111/j.1464-5491.2012.03577.x.
Sulfonylureas have been shown to increase mortality when used in combination with metformin. This may not be a class effect of sulfonylureas, but rather secondary to differences in properties inherent to the individual sulfonylureas (hypoglycaemic risk, sulfonylurea receptor selectivity and effects on myocardial ischemic preconditioning). The purpose of this study was to assess the risk of overall mortality in patients with Type 2 diabetes treated with different combinations of sulfonylureas and metformin.
A retrospective cohort study was conducted using an academic health center enterprise-wide electronic health record system to identify 7320 patients with Type 2 diabetes (3768 initiators of glyburide (glibenclamide) and metformin, 2277 initiators of glipizide and metformin and 1275 initiators of glimepiride and metformin), ≥ 18 years of age and not on insulin or a non-insulin injectable at baseline. The patients were followed for mortality by documentation in the electronic health record and Social Security Death Index. Multivariable Cox models with propensity analysis were used to compare cohorts.
No statistically significant difference in overall mortality risk was observed among the different combinations of sulfonylureas and metformin: glimepiride and metformin vs. glipizide and metformin (HR 1.03; 95% CI 0.89-1.20), glimepiride and metformin vs. glyburide (glibenclamide) and metformin (HR 1.08; 95% CI 0.90-1.30), or with glipizide and metformin vs. glyburide (glibenclamide) and metformin (HR 1.05; 95% CI 0.95-1.15).
Our results did not identify an increased mortality risk among the different combinations of sulfonylureas and metformin, suggesting that overall mortality is not substantially influenced by the choice of sulfonylurea.
磺酰脲类药物与二甲双胍联合使用时已被证明会增加死亡率。这可能不是磺酰脲类药物的类效应，而是由于个体磺酰脲类药物固有的特性差异所致（低血糖风险、磺酰脲受体选择性和对心肌缺血预适应的影响）。本研究旨在评估不同磺酰脲类药物与二甲双胍联合治疗 2 型糖尿病患者的总体死亡率风险。
本研究使用学术医疗中心的企业级电子健康记录系统进行回顾性队列研究，以确定 7320 名 2 型糖尿病患者（3768 名格列吡嗪（格列本脲）和二甲双胍的起始使用者，2277 名格列美脲和二甲双胍的起始使用者，1275 名格列齐特和二甲双胍的起始使用者），年龄≥18 岁，基线时未使用胰岛素或非胰岛素注射剂。通过电子健康记录和社会保障死亡指数记录患者的死亡率，并进行随访。采用倾向评分分析的多变量 Cox 模型比较队列。
不同磺酰脲类药物与二甲双胍联合使用的总体死亡率风险无统计学差异：格列美脲和二甲双胍与格列吡嗪和二甲双胍（HR 1.03；95%CI 0.89-1.20）、格列美脲和二甲双胍与格列本脲（格列吡嗪）和二甲双胍（HR 1.08；95%CI 0.90-1.30），或格列吡嗪和二甲双胍与格列本脲（格列吡嗪）和二甲双胍（HR 1.05；95%CI 0.95-1.15）。
我们的研究结果并未发现不同磺酰脲类药物与二甲双胍联合使用的死亡率风险增加，这表明总体死亡率受磺酰脲类药物选择的影响不大。
