Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
J Am Geriatr Soc. 2013 Aug;61(8):1253-61. doi: 10.1111/jgs.12381. Epub 2013 Jul 26.
To assess the distribution of antihyperglycemic treatments according to age and renal function and its relationship with cardiovascular disease in type 2 diabetes mellitus (T2DM).
Cross-sectional analysis.
Nineteen hospital-based diabetes mellitus clinics in 2007 and 2008.
Fifteen thousand seven hundred thirty-three individuals with T2DM from the Renal Insufficiency and Cardiovascular Events (RIACE) Italian Multicenter Study.
Current antihyperglycemic treatments were recorded. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Albuminuria was measured using immunonephelometry or immunoturbidimetry. Prevalence of major acute cardiovascular events was calculated according to age quartiles, treatments, and categories of eGFR (1 = ≥90; 2 = 60-89; 3 = 30-59; and 4 = <30 mL/min per 1.73 m(2) ).
Across age quartiles, eGFR declined progressively at a time-linear rate, with an acceleration in older adults, whereas albuminuria increased; age and eGFR were associated with cardiovascular events independently of other confounders. With increasing age, percentage of participants using lifestyle treatments for their T2DM and taking metformin or glitazones fell; percentage taking sulphonylureas and repaglinide rose, and percentage taking insulin remained stable. In eGFR categories 3 and 4, use of metformin was 41.4% and 14.5%, respectively, and that of sulphonylureas was 34.2% and 18.1%, respectively. Inappropriate prescription of these agents, especially sulphonylureas, increased with age. Metformin was independently associated with lower prevalence of cardiovascular disease for any age quartile and eGFR category than all other treatments.
In real-life conditions, use of agents that are not recommended in elderly adults with diabetes mellitus with moderate to severe renal impairment is frequent, but metformin is associated with lower cardiovascular event rates even in these individuals.
评估根据年龄和肾功能分布的抗高血糖治疗情况及其与 2 型糖尿病（T2DM）心血管疾病的关系。
横断面分析。
2007 年和 2008 年 19 家医院的糖尿病诊所。
来自肾脏不足和心血管事件（RIACE）意大利多中心研究的 15733 名 T2DM 个体。
记录当前的抗高血糖治疗情况。使用慢性肾脏病流行病学合作方程（Chronic Kidney Disease Epidemiology Collaboration equation）计算估计肾小球滤过率（eGFR）。使用免疫比浊法或免疫散射比浊法测量白蛋白尿。根据年龄四分位、治疗和 eGFR 类别（1 = ≥90；2 = 60-89；3 = 30-59；4 = <30 mL/min/1.73 m²）计算主要急性心血管事件的发生率。
在各个年龄四分位中，eGFR 呈线性下降趋势，老年人加速下降，而白蛋白尿增加；年龄和 eGFR 与心血管事件独立相关，不受其他混杂因素影响。随着年龄的增长，使用生活方式治疗 T2DM 和服用二甲双胍或噻唑烷二酮的患者比例下降；服用磺脲类药物和瑞格列奈的比例上升，而使用胰岛素的比例保持稳定。在 eGFR 类别 3 和 4 中，分别有 41.4%和 14.5%的患者使用二甲双胍，而磺脲类药物的使用比例分别为 34.2%和 18.1%。这些药物的不适当处方，尤其是磺脲类药物，随着年龄的增长而增加。与其他所有治疗方法相比，二甲双胍与任何年龄四分位和 eGFR 类别下的心血管疾病发生率较低独立相关。
在现实生活条件下，在有中度至重度肾功能损害的老年糖尿病患者中使用不推荐的药物很常见，但即使在这些患者中，二甲双胍也与较低的心血管事件发生率相关。
