Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA.
Ann Pharmacother. 2013 Oct;47(10):1280-91. doi: 10.1177/1060028013503624.
Among adults with incident diabetes, data are lacking about first antihyperglycemic initiation and whether medication choice aligns with recommendations.
To identify predictors of initiating any antihyperglycemic, and specifically sulfonylurea versus metformin.
This retrospective cohort study included 241 327 patients from 11 US health systems, 2005 through 2010. Assessments included antihyperglycemic initiation within 6 months of diabetes identification, first medication initiated, and initiation predictors.
Only 40.3% (n = 97 350) started any antihyperglycemic; 75.2% (n = 73 221) started metformin. Glycosylated hemoglobin (HbA1c) predicted initiating any antihyperglycemic (HbA1c >9%, relative risk [RR] = 3.94, 95% CI = 3.82, 4.07, vs HbA1c >6.5%-7%). Age modified the HbA1c effect: at higher HbA1c, likelihood of starting antihyperglycemics differed little across ages; at lower HbA1c, older patients were less likely to start antihyperglycemics (P < .001). Individuals with elevated serum creatinine (SCr) were more likely to started on sulfonylurea (SCr = 1.4-2, RR = 2.21 [2.05, 2.39]; SCr >2, RR = 2.75 [2.30, 3.29] vs normal SCr), particularly as HbA1c increased: patients with HbA1c 8%-9% and SCr >2 were 5.59 times (2.94, 10.65) more likely to start sulfonylurea versus those with HbA1c >6.5%-7% and normal SCr. Age predicted sulfonylurea initiation (20-39 years, RR = 0.87 [0.79, 0.95]; ≥ 80 years, RR = 2.41 [2.20, 2.65] vs 50-59 years).
Among adults with incident diabetes, metformin was generally the first antihyperglycemic initiated. However, 59.7% did not start any antihyperglycemic at diabetes identification. HbA1c and age predict antihyperglycemic initiation; SCr and age predict sulfonylurea initiation.
在新诊断为糖尿病的成年人中，缺乏关于首次使用抗高血糖药物的起始以及药物选择是否符合推荐的相关数据。
确定使用任何抗高血糖药物起始治疗（包括磺酰脲类药物和二甲双胍）的预测因素。
本回顾性队列研究纳入了来自美国 11 个医疗系统的 241327 名患者，时间范围为 2005 年至 2010 年。评估包括糖尿病确诊后 6 个月内抗高血糖药物起始治疗、起始治疗药物以及预测因素。
仅有 40.3%（n=97350）的患者使用了任何一种抗高血糖药物；75.2%（n=73221）的患者起始使用了二甲双胍。糖化血红蛋白（HbA1c）预测了使用任何抗高血糖药物起始治疗（HbA1c＞9%，相对风险[RR]为 3.94，95%CI为 3.82，4.07，vs HbA1c＞6.5%-7%）。年龄改变了 HbA1c 的影响：在较高的 HbA1c 水平下，不同年龄段开始使用抗高血糖药物的可能性差异较小；在较低的 HbA1c 水平下，年龄较大的患者不太可能开始使用抗高血糖药物（P＜0.001）。血清肌酐（SCr）升高的患者更有可能起始使用磺酰脲类药物（SCr=1.4-2，RR=2.21[2.05，2.39]；SCr＞2，RR=2.75[2.30，3.29]，vs 正常 SCr），尤其是在 HbA1c 升高时：HbA1c 为 8%-9%且 SCr＞2 的患者起始使用磺酰脲类药物的可能性是 HbA1c ＞6.5%-7%且 SCr 正常的患者的 5.59 倍（2.94，10.65）。年龄预测了磺酰脲类药物的起始治疗（20-39 岁，RR=0.87[0.79，0.95]；≥80 岁，RR=2.41[2.20，2.65]，vs 50-59 岁）。
在新诊断为糖尿病的成年人中，二甲双胍通常是首先使用的抗高血糖药物。然而，有 59.7%的患者在确诊时并未使用任何抗高血糖药物。HbA1c 和年龄预测抗高血糖药物的起始治疗；SCr 和年龄预测磺酰脲类药物的起始治疗。
