有意控制体重和减少抗糖尿病药物剂量——一项回顾性队列研究。
Intentional weight loss and dose reductions of anti-diabetic medications--a retrospective cohort study.
机构信息
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
出版信息
PLoS One. 2012;7(2):e32395. doi: 10.1371/journal.pone.0032395. Epub 2012 Feb 27.
BACKGROUND AND AIM
Intentional weight loss, primarily by improving insulin resistance, is known to decrease the need for anti-diabetic medications. In this study, we assess the magnitude of weight loss that resulted in dose reductions or discontinuation of anti-diabetic medications in overweight or obese patients with type 2 diabetes (DM) undergoing weight loss treatment.
METHODS
Case records of 50 overweight or obese patients with DM who successfully decreased dosage or discontinued diabetes medications after losing weight via attendance at two University-based, outpatient weight management centers were analyzed. Follow-up visits, weight reduction interventions, and decisions for dose reductions or discontinuation of medications were individualized to patient needs by the treating physician.
RESULTS
Mean starting BMI was 35 kg/m(2), mean age 53.4 years, and 58% were male. All 50 used at least one anti-diabetic medication (30 metformin, 39 sulfonylureas, 31 insulin, 21 sitagliptin) to manage blood sugar. Mean duration of follow-up was 30.2 months. Mean weight loss was 10.8 ± 4.1 kgs (11.1% of initial body weight ± 4.7%). 22/50 patients (44%) discontinued anti-diabetes medications (14 sulfonylureas [36%], 7 insulin [23%], 4 sitagliptin [19%]). The mean percentage weight loss achieved at the point of successful discontinuation of medication was 11.2% ± 3.5% (14% for sulphonylureas, 11% for insulin, and 7.1% for sitagliptin). Mean percentage weight loss of 5.6% ± 2.8% (5.1% for sulphonylureas, 4.3% for insulin, and 7.1% for sitagliptin) was required for initial dose reduction. For every 5% weight loss, predicted dose reductions were sulphonylureas, 39%; insulin, 42%; and any anti-diabetic medications, 49%.
CONCLUSION
Among overweight or obese patients with type 2 diabetes, intentional weight loss of 7-14% was typically required for full discontinuation of at least one anti-diabetic medication. Discontinuation of insulin was achieved at a mean weight reduction of 11% of initial body weight.
背景与目的
通过改善胰岛素抵抗，实现有目的的体重减轻，已知可减少对糖尿病药物的需求。在这项研究中，我们评估了超重或肥胖的 2 型糖尿病（DM）患者在接受减肥治疗后，体重减轻导致抗糖尿病药物剂量减少或停药的幅度。
方法
分析了 50 例超重或肥胖的 2 型糖尿病患者的病历记录，这些患者通过参加两所大学的门诊体重管理中心的减肥治疗，成功减少了药物剂量或停止使用糖尿病药物。治疗医生根据患者的需求，对随访、减肥干预和减少药物剂量或停药的决定进行个体化。
结果
平均起始 BMI 为 35kg/m2，平均年龄为 53.4 岁，58%为男性。所有 50 例患者均使用至少一种抗糖尿病药物（30 例二甲双胍、39 例磺酰脲类、31 例胰岛素、21 例西格列汀）来控制血糖。平均随访时间为 30.2 个月。平均体重减轻 10.8±4.1kg（初始体重的 11.1%±4.7%）。22/50 例患者（44%）停止使用抗糖尿病药物（14 例磺酰脲类[36%]、7 例胰岛素[23%]、4 例西格列汀[19%]）。成功停药时达到的药物剂量成功减少的平均体重百分比为 11.2%±3.5%（磺酰脲类为 14%，胰岛素为 11%，西格列汀为 7.1%）。初始剂量减少需要 5.6%±2.8%（磺酰脲类为 5.1%，胰岛素为 4.3%，西格列汀为 7.1%）的平均体重百分比减少。每减少 5%的体重，预测磺酰脲类药物的剂量减少 39%；胰岛素的剂量减少 42%；任何抗糖尿病药物的剂量减少 49%。
结论
在超重或肥胖的 2 型糖尿病患者中，通常需要有目的的体重减轻 7-14%，才能完全停止至少一种抗糖尿病药物。胰岛素的停药平均需要初始体重减少 11%。
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