Diabetes-Zentrum Quakenbrück, Fachabteilung fur Diabetologie, Stoffwechsel und Endokrinologie am Christlichen Krankenhaus, Klinisches Diabeteszentrum der DDG, Akademisches Lehrkrankenhausder Medizinischen Hochschule Hannover, Danziger Str.10, 49610, Quakenbruck, Germany,
Diabetes Ther. 2012 Nov;3(1):6. doi: 10.1007/s13300-012-0006-7. Epub 2012 Jun 20.
Changes to Treatment and Outcomes in Patients with Type 2 Diabetes Initiating Injectable Therapy (CHOICE) is a European prospective, observational cohort study assessing time to, and factors associated with, a significant change in therapy after type 2 diabetes patients initiate their first injectable glucose-lowering therapy, and these patients' clinical outcomes over 24 months. The authors report baseline data and factors associated with the injectable treatment regimen.
Demographic, clinical, and healthcare resource-use data were collected at initiation of injectable therapy and analyzed using univariate tests between cohorts and multivariate logistic regression analysis for treatment.
Overall, 1,177 patients initiated exenatide twice daily (b.i.d.) and 1,315 initiated insulin. Most patients were recruited by secondary-care physicians. Univariate analyses revealed statistically significant differences between the characteristics of patients who initiated exenatide b.i.d. and patients who initiated insulin. On multivariate analysis, higher body mass index [BMI; 5 kg/m(2) higher: odds ratio (OR) 2.10, 95% confidence intervals (CI) 1.84-2.40], lower glycated hemoglobin (HbA(1c); 1% higher: OR 0.77, 95% CI 0.69-0.86), and lower age (5 years older: OR 0.82, 95% CI 0.76-0.88) were the variables most strongly associated with increased probability of receiving exenatide b.i.d. (P < 0.0001). Patients initiating exenatide b.i.d. had a mean BMI of 35.3 ± 6.5 kg/m(2), HbA(1c) of 8.4 ± 1.4%, and age of 58 ± 10 years, compared with 29.7 ± 5.4 kg/m(2), 9.2 ± 1.9%, and 64 ± 11 years, respectively, in patients initiating insulin (P < 0.0001). Other characteristics significantly associated with exenatide b.i.d. initiation were "disinhibited eating" (Diabetes Health Profile-18), lower random blood glucose, less blood glucose self-monitoring, lower low-density lipoprotein cholesterol, and receipt of diet/exercise advice.
Patients who initiated exenatide b.i.d. were on average younger and more obese with lower HbA(1c) than those initiating insulin.
CHOICE 研究是一项在欧洲开展的前瞻性观察性队列研究，旨在评估 2 型糖尿病患者起始首次注射用降糖药物后，药物治疗发生显著改变的时间以及相关影响因素，并对 24 个月内患者的临床结局进行随访。本文报告了基线数据和与注射治疗方案相关的因素。
收集起始注射用降糖药物治疗时的人口统计学、临床和医疗资源利用数据，并分别采用单变量检验和多变量逻辑回归分析进行组间比较和治疗分析。
共纳入 1177 例起始接受每日 2 次艾塞那肽治疗的患者和 1315 例起始接受胰岛素治疗的患者。大多数患者由二级医疗机构医生招募。单变量分析显示，起始接受艾塞那肽治疗和起始接受胰岛素治疗的患者特征存在统计学差异。多变量分析显示，较高的体重指数（BMI）[每增加 5kg/m2：比值比（OR）2.10，95%置信区间（CI）1.84-2.40]、较低的糖化血红蛋白（HbA1c）[每增加 1%：OR 0.77，95%CI 0.69-0.86]和较低的年龄（每增加 5 岁：OR 0.82，95%CI 0.76-0.88）与接受艾塞那肽治疗的概率增加显著相关（P<0.0001）。起始接受艾塞那肽治疗的患者 BMI 平均值为 35.3±6.5kg/m2，HbA1c 为 8.4±1.4%，年龄为 58±10 岁，而起始接受胰岛素治疗的患者 BMI 平均值为 29.7±5.4kg/m2，HbA1c 为 9.2±1.9%，年龄为 64±11 岁（P<0.0001）。与起始接受艾塞那肽治疗相关的其他特征还包括“冲动性饮食”（糖尿病健康问卷-18 项）、较低的随机血糖、较少的血糖自我监测、较低的低密度脂蛋白胆固醇和接受饮食/运动建议。
与起始接受胰岛素治疗的患者相比，起始接受艾塞那肽治疗的患者平均年龄较小、体重更重，且 HbA1c 更低。
