Paul Sanjoy K, Klein Kerenaftali, Maggs David, Best Jennie H
Clinical Trials & Biostatistics Unit, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Brisbane, Australia.
Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
Cardiovasc Diabetol. 2015 Jan 24;14:10. doi: 10.1186/s12933-015-0178-3.
To evaluate the association of treatment with glucagon-like peptide-1 (GLP-1) receptor agonist exenatide and/or insulin on macrovascular outcomes in patients with type 2 diabetes (T2DM).
We conducted a retrospective longitudinal pharmaco-epidemiological study using large ambulatory care data to evaluate the risks of heart failure (HF), myocardial infarction (MI) and stroke in established T2DM patients who received a first prescription of exenatide twice daily (EBID) or insulin between June 2005 and May 2009, with follow-up data available until December 2012. Three treatment groups were: EBID with oral antidiabetes drugs (OADs) (EBID, n = 2804), insulin with OADs (Insulin, n = 28551), and those who changed medications between EBID and insulin or had combination of EBID and insulin during follow-up, along with OADs (EBID + insulin, n = 7870). Multivariate Cox-regression models were used to evaluate the association of treatment groups with the risks of macrovascular events.
During a median 3.5 years of follow-up, cardiovascular event rates per 1000 person-years were significantly lower for the EBID and EBID + insulin groups compared to the insulin group (HF: 4.4 and 6.1 vs. 17.9; MI: 1.1 and 1.2 vs. 2.5; stroke: 2.4 and 1.8 vs. 6.1). Patients in the EBID/EBID + insulin group had significantly reduced risk of HF, MI and stroke by 61/56%, 50/38% and 52/63% respectively, compared to patients in the insulin group (p < 0.01).
Treatment with exenatide, with or without concomitant insulin was associated with reduced macrovascular risks compared to insulin; although inherent potential bias in epidemiological studies should be considered.
评估胰高血糖素样肽-1（GLP-1）受体激动剂艾塞那肽和/或胰岛素治疗与2型糖尿病（T2DM）患者大血管结局的关联。
我们利用大型门诊护理数据进行了一项回顾性纵向药物流行病学研究，以评估2005年6月至2009年5月期间首次接受每日两次艾塞那肽（EBID）或胰岛素处方的已确诊T2DM患者发生心力衰竭（HF）、心肌梗死（MI）和中风的风险，并获取随访数据直至2012年12月。三个治疗组分别为：联用口服抗糖尿病药物（OADs）的EBID组（EBID，n = 2804）、联用OADs的胰岛素组（胰岛素组，n = 28551），以及在随访期间在EBID和胰岛素之间换药或联用EBID和胰岛素并联用OADs的患者（EBID + 胰岛素组，n = 7870）。采用多变量Cox回归模型评估治疗组与大血管事件风险的关联。
在中位3.5年的随访期间，与胰岛素组相比，EBID组和EBID + 胰岛素组每1000人年的心血管事件发生率显著更低（HF：4.4和6.1对17.9；MI：1.1和1.2对2.5；中风：2.4和1.8对6.1）。与胰岛素组患者相比，EBID/EBID + 胰岛素组患者发生HF、MI和中风的风险分别显著降低61/56%、50/38%和52/63%（p < 0.01）。
与胰岛素相比，使用艾塞那肽治疗（无论是否联用胰岛素）与降低大血管风险相关；尽管应考虑流行病学研究中固有的潜在偏倚。
