Therapeutics Initiative, University of British Columbia, Vancouver, Canada.
BMJ Open. 2012 Nov 12;2(6). doi: 10.1136/bmjopen-2012-001910. Print 2012.
To understand the independent role of thiazolidinediones (TZDs) in delaying progression to parenteral insulin therapy.
Population-based retrospective cohort study.
British Columbia, Canada.
A total of 18 867 type 2 diabetes patients (mean age 58.9) treated with metformin as first-line therapy who then switched or added a TZD or sulphonylurea as a second-line treatment between 1 January 1998 and 31 March 2008.
Multivariable Poisson regression models were used to estimate the effect of using TZD compared to sulphonylureas on time to the initiation of insulin treatment (third-line).
The adjusted rate difference in women aged <60 showed 2.22 fewer insulin initiation events per 100 person-years (PYs) in the TZD group versus the sulphonylurea group (95% CI -3.46 to -0.99). Men in the same age group had 1.50 fewer insulin initiation events per 100 PYs in the TZD group versus the sulphonylurea group (95% CI -2.44 to -0.56). The average time in days to initiation on insulin in the sulphonylurea, rosiglitazone and pioglitazone group was 343, 252 and 339, respectively. The cumulative hazard for starting insulin for sulphonylurea patients at 12, 24, 36 and 48 months was approximately three times higher compared to TZD patients.
Second-line TZD therapy compared to second-line sulphonylurea therapy was associated with a lower incidence of insulin initiation as third-line treatment in patients with type 2 diabetes, with a mean delay of 90 days. This duration of delay must be weighed against the absence of a proven reduction in morbidity or mortality with TZDs and their known serious cardiovascular harm.
了解噻唑烷二酮（TZDs）在延迟转为胰岛素注射治疗方面的独立作用。
基于人群的回顾性队列研究。
加拿大不列颠哥伦比亚省。
共纳入 18867 名接受二甲双胍作为一线治疗的 2 型糖尿病患者（平均年龄 58.9 岁），随后在 1998 年 1 月 1 日至 2008 年 3 月 31 日期间，他们改用或加用 TZD 或磺酰脲类药物作为二线治疗。
采用多变量泊松回归模型，评估与磺酰脲类药物相比，使用 TZD 对开始胰岛素治疗（三线治疗）时间的影响。
在年龄＜60 岁的女性中，与磺酰脲类药物组相比，TZD 组每 100 人年（PY）胰岛素起始事件减少 2.22 例（95%可信区间-3.46 至-0.99）。年龄相同的男性中，TZD 组每 100 PY 的胰岛素起始事件比磺酰脲类药物组减少 1.50 例（95%可信区间-2.44 至-0.56）。磺酰脲类药物、罗格列酮和吡格列酮组开始胰岛素治疗的平均天数分别为 343、252 和 339 天。磺酰脲类药物患者在 12、24、36 和 48 个月开始使用胰岛素的累积风险大约是 TZD 患者的 3 倍。
与二线磺酰脲类药物治疗相比，二线 TZD 治疗与 2 型糖尿病患者转为胰岛素治疗的发生率较低，三线治疗的平均延迟时间为 90 天。这种延迟时间必须与 TZDs 无明显降低发病率或死亡率以及其已知的严重心血管危害相权衡。
