Clinical Practice Research Datalink, MHRA, London, UK.
Merck Sharp & Dohme Ltd, Hoddesdon, UK.
Diabetes Obes Metab. 2015 Jun;17(6):573-580. doi: 10.1111/dom.12458. Epub 2015 Apr 6.
To compare diabetes-associated secondary healthcare utilization in patients with type 2 diabetes (T2DM) prescribed sulphonylureas (SUs) versus other oral antihyperglycaemic agents (OHAs) as an add-on to metformin monotherapy (metformin + SU vs metformin + OHA).
This retrospective cohort study used data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics. Adults with T2DM initiated on metformin + SU or metformin + OHA from April 2003 to March 2012 were identified. Patients were matched using propensity scores. Diabetes-associated secondary healthcare visits were counted from >6 months post-initiation of dual therapy until treatment change or end of follow-up. Outcomes were calculated as rate ratios, adjusted for over-dispersion using negative binomial regression and propensity score for covariates.
After propensity score matching, 1704 patients were included in each cohort. For the primary objective (diabetes-associated inpatient and outpatient visits combined), the metformin + SU cohort had a directionally higher rate of diabetes-associated secondary healthcare utilization than the metformin + OHA cohort [adjusted rate ratio 1.12, 95% confidence interval (CI) 0.97-1.29]. For the secondary outcomes, the adjusted rate ratio was 1.38 (95% CI 0.95-2.00) for inpatient admissions and 1.10 (95% CI 0.95-1.28) for outpatient visits. Macrovascular complications, accounting for 77.2% of inpatient admissions, occurred at a statistically significantly higher rate in the metformin + SU cohort than in the metformin + OHA cohort (adjusted rate ratio 1.77, 95% CI 1.15-2.71).
This study found a statistically significant higher rate of inpatient admissions for macrovascular complications and cardiology outpatient visits and, overall, a directionally higher rate of secondary healthcare utilization for patients prescribed metformin + SU than for those prescribed metformin + OHA. This adds to the evidence that long-term and health economic outcomes should be considered in treatment decisions for patients with type 2 diabetes.
比较在二甲双胍单药治疗的基础上加用磺脲类药物（SU）或其他口服降糖药（OHA）治疗 2 型糖尿病（T2DM）患者的糖尿病相关二级医疗保健利用情况。
本回顾性队列研究使用了临床实践研究数据链接到医院入院统计数据。从 2003 年 4 月至 2012 年 3 月，确定了起始二甲双胍+SU 或二甲双胍+OHA 治疗的 T2DM 成人患者。使用倾向评分进行患者匹配。从双联治疗开始后>6 个月开始计算糖尿病相关的二级医疗保健就诊次数，直至治疗改变或随访结束。使用负二项回归和倾向评分对协变量进行调整，计算结果为率比。
经过倾向评分匹配后，每个队列纳入了 1704 例患者。对于主要目标（糖尿病相关的住院和门诊就诊次数之和），二甲双胍+SU 队列的糖尿病相关二级医疗保健利用率呈上升趋势，高于二甲双胍+OHA 队列[调整后的率比 1.12，95%置信区间（CI）0.97-1.29]。对于次要结局，住院的调整后的率比为 1.38（95%CI 0.95-2.00），门诊就诊的调整后的率比为 1.10（95%CI 0.95-1.28）。占住院人数 77.2%的大血管并发症在二甲双胍+SU 队列中的发生率明显高于二甲双胍+OHA 队列（调整后的率比 1.77，95%CI 1.15-2.71）。
本研究发现，在大血管并发症住院和心血管科门诊就诊方面，服用二甲双胍+SU 的患者的住院率显著升高，总体而言，与服用二甲双胍+OHA 的患者相比，服用二甲双胍+SU 的患者的二级医疗保健利用率呈上升趋势。这进一步证明，在 2 型糖尿病患者的治疗决策中应考虑长期和健康经济效益。
