Department of Medicine, Western University, London, ON, Canada.
Institute for Clinical Evaluative Sciences, ON, Canada.
Diabetes Obes Metab. 2016 Jun;18(6):607-14. doi: 10.1111/dom.12658. Epub 2016 Apr 12.
To examine how antihyperglycaemic medications were prescribed to older adults with diabetes and chronic kidney disease over the last decade.
We conducted a population-based study of 144 252 older adults with diabetes and chronic kidney disease (estimated glomerular filtration rate <60 ml/min/1.73 m(2) or receiving chronic dialysis) in Ontario, Canada. In each study quarter (3-month intervals from 1 April 2004 until 31 March 2013) we studied the proportion of treated and newly treated patients prescribed insulin, sulphonylureas, α-glucosidase inhibitors, metformin, thiazolidinediones, meglitinides and dipeptidyl peptidase-4 (DPP-4) inhibitors. We further examined prescription trends by stage of chronic kidney disease.
The mean age of patients increased slightly (from 76 to 78 years) over the study period and the percentage with comorbidities declined. Metformin was the predominant therapy prescribed (prescribed to a mean of 56.1% of treated patients). Glyburide (glibenclamide) and thiazolidinedione prescriptions decreased (glyburide prescriptions declined from 45.5 to 9.5%, rosiglitazone from 3.6 to 0.2% and pioglitazone from 1.9 to 1.7%), while gliclazide and DPP-4 inhibitor prescriptions increased (gliclazide prescriptions increased from 0.6 to 26.4%, sitagliptin from 0 to 15.3% and saxagliptin from 0 to 2.0%). Up to 48.6% of patients with stage 3a-5 chronic kidney disease or receiving chronic dialysis were prescribed glyburide, and up to 27.6% of patients with stage 4-5 disease or receiving chronic dialysis were prescribed metformin.
In patients with chronic kidney disease, there were trends towards safer antihyperglycaemic medication prescribing. A considerable number of patients, however, continue to receive medications that should be avoided.
考察过去十年中，患有糖尿病和慢性肾病的老年患者的降糖药物治疗方案。
我们在加拿大安大略省开展了一项基于人群的研究，共纳入 144252 例患有糖尿病和慢性肾病（估算肾小球滤过率＜60ml/min/1.73m²或接受慢性透析）的老年患者。在每个研究季度（2004 年 4 月 1 日至 2013 年 3 月 31 日的每 3 个月间隔），我们研究了接受治疗和新接受治疗的患者中，处方胰岛素、磺酰脲类、α-葡萄糖苷酶抑制剂、二甲双胍、噻唑烷二酮类、格列奈类和二肽基肽酶-4（DPP-4）抑制剂的比例。我们进一步按慢性肾病分期检查了处方趋势。
研究期间，患者的平均年龄略有增加（从 76 岁增至 78 岁），合并症的比例有所下降。二甲双胍是最常用的治疗药物（56.1%的接受治疗的患者处方了二甲双胍）。格列吡嗪（glibenclamide，glyburide）和噻唑烷二酮类药物的处方量减少（格列吡嗪的处方量从 45.5%降至 9.5%，罗格列酮从 3.6%降至 0.2%，吡格列酮从 1.9%降至 1.7%），而格列齐特和 DPP-4 抑制剂的处方量增加（格列齐特的处方量从 0.6%增至 26.4%，西他列汀从 0%增至 15.3%，沙格列汀从 0%增至 2.0%）。多达 48.6%的慢性肾病 3a-5 期或接受慢性透析的患者处方了格列吡嗪，多达 27.6%的慢性肾病 4-5 期或接受慢性透析的患者处方了二甲双胍。
在患有慢性肾病的患者中，降糖药物的处方治疗有向更安全的方向发展的趋势。然而，仍有相当数量的患者接受应避免使用的药物。
