Ann Intern Med. 2015 Nov 3;163(9):663-72. doi: 10.7326/M15-0308. Epub 2015 Oct 13.
Recent studies concluded that dipeptidyl peptidase-4 (DPP-4) inhibitors provide glycemic control but also raised concerns about the risk for heart failure in patients with type 2 diabetes mellitus (T2DM). However, large-scale studies of the effects on cardiovascular outcomes of adding DPP-4 inhibitors versus sulfonylureas to metformin therapy remain scarce.
To compare clinical outcomes of adding DPP-4 inhibitors versus sulfonylureas to metformin therapy in patients with T2DM.
Nationwide study using Taiwan's National Health Insurance Research Database.
Taiwan.
All patients with T2DM aged 20 years or older between 2009 and 2012. A total of 10,089 propensity score-matched pairs of DPP-4 inhibitor users and sulfonylurea users were examined.
Cox models with exposure to sulfonylureas and DPP-4 inhibitors included as time-varying covariates were used to compare outcomes. The following outcomes were considered: all-cause mortality, major adverse cardiovascular events (MACEs) (including ischemic stroke and myocardial infarction), hospitalization for heart failure, and hypoglycemia. Patients were followed until death or 31 December 2013.
DPP-4 inhibitors were associated with lower risks for all-cause death (hazard ratio [HR], 0.63 [95% CI, 0.55 to 0.72]), MACEs (HR, 0.68 [CI, 0.55 to 0.83]), ischemic stroke (HR, 0.64 [CI, 0.51 to 0.81]), and hypoglycemia (HR, 0.43 [CI, 0.33 to 0.56]) compared with sulfonylureas as add-on therapy to metformin but had no effect on risks for myocardial infarction and hospitalization for heart failure.
Observational study design.
Compared with sulfonylureas, DPP-4 inhibitors were associated with lower risks for all-cause death, MACEs, ischemic stroke, and hypoglycemia when used as add-ons to metformin therapy.
None.
最近的研究得出结论，二肽基肽酶-4（DPP-4）抑制剂可控制血糖，但也引发了对 2 型糖尿病（T2DM）患者心力衰竭风险的担忧。然而，关于添加 DPP-4 抑制剂与磺酰脲类药物对比二甲双胍治疗对心血管结局影响的大规模研究仍然很少。
比较在 T2DM 患者中添加 DPP-4 抑制剂与磺酰脲类药物对比二甲双胍治疗的临床结局。
使用台湾全民健康保险研究数据库进行的全国性研究。
台湾。
2009 年至 2012 年间年龄在 20 岁或以上的所有 T2DM 患者。共检查了 10089 对 DPP-4 抑制剂使用者和磺酰脲类药物使用者的倾向评分匹配对。
使用暴露于磺酰脲类药物和 DPP-4 抑制剂的 Cox 模型作为时间变化的协变量来比较结局。考虑了以下结局：全因死亡率、主要不良心血管事件（MACE）（包括缺血性卒中和心肌梗死）、心力衰竭住院和低血糖。患者随访至死亡或 2013 年 12 月 31 日。
与磺酰脲类药物相比，DPP-4 抑制剂作为二甲双胍的附加疗法与全因死亡风险降低相关（风险比 [HR]，0.63 [95%CI，0.55 至 0.72]）、MACE（HR，0.68 [CI，0.55 至 0.83]）、缺血性卒中和低血糖（HR，0.64 [CI，0.51 至 0.81]），但对心肌梗死和心力衰竭住院风险没有影响。
观察性研究设计。
与磺酰脲类药物相比，DPP-4 抑制剂作为二甲双胍治疗的附加疗法与全因死亡、MACE、缺血性卒中和低血糖风险降低相关。
无。
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