Simonyi Gábor, Ferenci Tamás
Anyagcsere Központ, Szent Imre Egyetemi Oktatókórház Budapest, Tétényi út 12-16., 1115.
Élettani Szabályozások Csoport, Óbudai Egyetem, Neumann János Informatikai Kar Budapest.
Orv Hetil. 2016 Apr 17;157(16):618-22. doi: 10.1556/650.2016.30423.
In treatment of type 2 diabetes mellitus it is important to reach glycaemic targets. The elements of this are the adequate diet and the patient's adherence to medication.
The aim of the authors was to investigate the one year persistence of the metformin monotherapy and sitagliptin/metformin fixed dose combination in type 2 diabetic patients.
National Health Insurance Found prescriptions database of Hungary on pharmacy-claims between October 1, 2012 and September 30, 2013 was analyzed. The authors identified patients who filled prescriptions for metformin monotherapy and fixed dose combinations of sitagliptin/metformin prescribed for the first time. Patients have not received similar drugs one year previous to study. To model the persistence, the apparatus of survival analysis was used, where "survival" was the time to abandon the medication. As it was available to month precision, discrete time survival analysis was applied: a generalized linear model was estimated with complementary log-log link function with the kind of drug being the only explanatory variable.
During the trial period, metformin monotherapy or sitagliptin/metformin fixed dose combination was started in 63,386 and 10,039 patients, respectively. One year persistence rate in patients with metformin monotherapy was 30%, and 58% in patients with sitagliptin/metformin fixed dose combination. Considering only the 360-day study period, the mean duration of persistence was 173.4 days in patients on metformin monotherapy and 261.9 days on sitagliptin/metformin fixed dose combination. The hazard of discontinuation was more than twofold higher during treatment with metformin monotherapy compared with the use of the sitagliptin/metformin fixed dose combination (hazard ratio = 2.267, p<0.001).
There is a significant difference between the one year persistence of metformin monotherapy and sitagliptin/metformin fixed dose combination in type 2 diabetic patients. The result demonstrated sitagliptin/metformin fixed dose combination has a favourable patients' adherence as compared to metformin monotherapy.
在2型糖尿病的治疗中，实现血糖目标至关重要。这其中包括适当的饮食以及患者对药物治疗的依从性。
作者的目的是研究二甲双胍单药治疗和西格列汀/二甲双胍固定剂量联合治疗在2型糖尿病患者中的一年持续用药情况。
分析了匈牙利国家健康保险基金2012年10月1日至2013年9月30日期间药房报销处方数据库。作者确定了首次开具二甲双胍单药治疗处方和西格列汀/二甲双胍固定剂量联合治疗处方的患者。患者在研究前一年未接受过类似药物治疗。为了模拟持续用药情况，使用了生存分析方法，其中“生存”是指停止用药的时间。由于数据精确到月份，因此应用了离散时间生存分析：估计了一个广义线性模型，使用互补对数-对数链接函数，药物类型是唯一的解释变量。
在试验期间，分别有63386例和10039例患者开始使用二甲双胍单药治疗或西格列汀/二甲双胍固定剂量联合治疗。二甲双胍单药治疗患者的一年持续用药率为30%，西格列汀/二甲双胍固定剂量联合治疗患者为58%。仅考虑360天的研究期，二甲双胍单药治疗患者的平均持续用药时间为173.4天，西格列汀/二甲双胍固定剂量联合治疗患者为261.9天。与使用西格列汀/二甲双胍固定剂量联合治疗相比，二甲双胍单药治疗期间停药风险高出两倍多（风险比=2.267，p<0.001）。
2型糖尿病患者中，二甲双胍单药治疗和西格列汀/二甲双胍固定剂量联合治疗的一年持续用药情况存在显著差异。结果表明，与二甲双胍单药治疗相比，西格列汀/二甲双胍固定剂量联合治疗具有更好的患者依从性。
