University of Utah, Pharmacotherapy Outcomes Research Center, Salt Lake City, UT, USA.
Global Health Economics and Outcomes Research, Bristol-Myers Squibb, Wallingford, CT, USA.
Diabetes Res Clin Pract. 2014 Mar;103(3):402-11. doi: 10.1016/j.diabres.2013.12.038. Epub 2014 Jan 3.
This study evaluates the relationship between HbA1c and weight change outcomes by anti-diabetic weight-effect properties in patients newly treated for type 2 diabetes; a relationship not previously characterized.
Electronic medical records of patients with type 2 diabetes newly prescribed anti-diabetic monotherapy were assessed to identify HbA1c goal attainment [(<53 mmol/mol)] and weight change at 1-year. Anti-diabetics were categorized by weight-effect properties: weight-gain (sulfonylureas, thiazolidinediones) and weight-loss/neutral (metformin, DPP-4 inhibitors, GLP-1 agonists). Logistic regression analyses identified likelihood of attaining HbA1c goal or ≥3% weight loss by anti-diabetic category controlling for baseline characteristics. MANOVA was used to identify correlation between changes in weight and HbA1c.
The study included 28,290 patients. Mean age ± sd was 61 years ±11.8. Baseline HbA1c was 7.4% ± 1.6 (57 mmol/mol ± 17); 67.3% were prescribed a weight-loss/neutral anti-diabetic. At 1-year, more patients in the weight-loss/neutral anti-diabetic category lost weight (≥3%) than in the weight-gain anti-diabetic category (40.4% vs. 24.2%, p<0.001) or had an HbA1c<7.0% (<53 mmol/mol) (71.1% vs. 63.8%, p<0.001). Those prescribed a weight-gain anti-diabetic were 53% less likely to lose weight and 29% less likely to be at HbA1c goal than those prescribed a weight-loss/neutral anti-diabetic (p<0.001). Weight loss and HbA1c outcomes were significantly correlated (p<0.001).
Weight loss of ≥3% was associated with better glycemic control in patients newly treated for type 2 diabetes. Anti-diabetics associated with weight-loss/neutrality were associated with greater weight loss and HbA1c goal attainment and may facilitate efforts to co-manage weight and glycemia in the ambulatory-care setting.
本研究评估了新诊断 2 型糖尿病患者的抗糖尿病体重效应特性与 HbA1c 和体重变化结局之间的关系；这一关系以前尚未得到描述。
评估了新接受抗糖尿病单药治疗的 2 型糖尿病患者的电子病历，以确定 1 年内的 HbA1c 达标（<53mmol/mol）和体重变化。根据体重效应特性对降糖药进行分类：增重（磺酰脲类、噻唑烷二酮类）和减重/中性（二甲双胍、DPP-4 抑制剂、GLP-1 激动剂）。通过多变量逻辑回归分析，在控制基线特征的情况下，确定了按降糖药类别达到 HbA1c 目标或体重减轻≥3%的可能性。MANOVA 用于确定体重和 HbA1c 变化之间的相关性。
该研究纳入了 28290 名患者。平均年龄±标准差为 61 岁±11.8 岁。基线 HbA1c 为 7.4%±1.6（57mmol/mol±17）；67.3%的患者开了减重/中性的降糖药。在 1 年内，更多服用减重/中性降糖药的患者体重减轻（≥3%），而服用增重降糖药的患者体重减轻（40.4% vs. 24.2%，p<0.001）或 HbA1c<7.0%（<53mmol/mol）（71.1% vs. 63.8%，p<0.001）。与服用减重/中性降糖药的患者相比，服用增重降糖药的患者体重减轻的可能性低 53%，达到 HbA1c 目标的可能性低 29%（p<0.001）。体重减轻和 HbA1c 结局显著相关（p<0.001）。
新诊断 2 型糖尿病患者体重减轻≥3%与血糖控制改善相关。与减重/中性相关的降糖药与更大的体重减轻和 HbA1c 目标达标相关，可能有助于在门诊环境中共同管理体重和血糖。
