Chen Hsin-Hung, Yeh Chih-Jung, Lin Cheng-Li, Yeh Su-Yin, Kao Chia-Hung
From the Institute of Public Health and Medicine, Chung Shan Medical University, Taichung (HHC, CJY); Division of Metabolism & Endocrinology, Changhua Christian Hospital, Changhua (HHC); Division of Metabolism & Endocrinology, Nantou Christian Hospital, Nantou (HHC, SYY); Management Office for Health Data, China Medical University Hospital (CLL); College of Medicine (CLL); Asia University, Taichung, Taiwan (SYY); Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine (CHK); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (CHK).
Medicine (Baltimore). 2015 May;94(17):e735. doi: 10.1097/MD.0000000000000735.
We evaluated the role of statins in delaying insulin use and diabetes-related diseases in Asian patients with type 2 diabetes mellitus (T2DM) because statins can cause new-onset diabetes.We used data from the Longitudinal Health Insurance Database in this retrospective cohort study. The 12,470 T2DM patients were categorized into 2 cohorts: a statin cohort comprising 2545 patients who received statin therapy for at least 6 months (180 days) before the index date and a nonstatin cohort comprising 9925 patients who did not receive statin therapy. The control-to-case ratio was set at approximately 4:1. Univariable and multivariable Cox proportional hazards regression analyses were performed to evaluate the risk of diabetes-related events and insulin use on receiving statin treatment.Patients in the statin cohort had a 48% lower risk of diabetes-related coma than those in the nonstatin cohort (95% confidence interval = 0.29-0.92). Patients with >730 days of statin therapy had a significantly lower risk of insulin use, diabetes-related disorders of the eye and neurons, and peripheral circulatory disorders. Compared with patients in the nonstatin cohort, the risk of insulin use, diabetes-related coma, and diabetes-related disorders of the eye and neurons was lower in patients on a cumulative defined daily dose (cDDD) of statins for >475 days.These results suggest that longer duration of statin use and higher cDDD of statins can delay insulin use in Asian patients with T2DM.
我们评估了他汀类药物在延缓亚洲2型糖尿病（T2DM）患者使用胰岛素及预防糖尿病相关疾病方面的作用，因为他汀类药物可引发新发糖尿病。在这项回顾性队列研究中，我们使用了纵向健康保险数据库中的数据。12470例T2DM患者被分为两个队列：他汀类药物队列，包括2545例在索引日期前接受他汀类药物治疗至少6个月（180天）的患者；非他汀类药物队列，包括9925例未接受他汀类药物治疗的患者。对照与病例的比例设定为约4:1。进行单变量和多变量Cox比例风险回归分析，以评估接受他汀类药物治疗时发生糖尿病相关事件及使用胰岛素的风险。他汀类药物队列中的患者发生糖尿病相关昏迷的风险比非他汀类药物队列中的患者低48%（95%置信区间=0.29-0.92）。接受他汀类药物治疗超过730天的患者使用胰岛素、发生糖尿病相关眼部和神经疾病以及外周循环系统疾病的风险显著降低。与非他汀类药物队列中的患者相比，累积限定日剂量（cDDD）的他汀类药物治疗超过475天的患者使用胰岛素、发生糖尿病相关昏迷以及糖尿病相关眼部和神经疾病的风险更低。这些结果表明，更长时间使用他汀类药物以及更高的他汀类药物cDDD可延缓亚洲T2DM患者使用胰岛素。
