Kocarnik Beverly M, Moore Kathryn P, Smith Nicholas L, Boyko Edward J
General Medicine and Hospital and Specialty Medicine Services, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, University of Washington, Seattle, WA, USA; Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
Diabetes Res Clin Pract. 2017 Jan;123:181-191. doi: 10.1016/j.diabres.2016.11.025. Epub 2016 Dec 5.
To investigate whether weight change in the first year after initiating an oral hypoglycemic agent (OHA) for type 2 diabetes treatment is associated with mortality in a national cohort.
We prospectively followed Veterans Health Administration patients with type 2 diabetes initiating treatment with an OHA and not receiving any other diabetes pharmacotherapy for at least one year. Information on OHAs, weight, co-morbidities, other medications, demographics, and laboratory measurements was obtained from electronic medical records. Logistic regression was used to estimate 5-year mortality odds by weight change during the first year after OHA treatment initiation.
Patients (mean age 65years, 97% male, mean BMI 32.3kg/m) initiating OHA monotherapy between 2003 and 2008 totaled 145,198 (metformin n=89,111, glipizide n=27,100, glyburide n=25,226, rosiglitazone n=3,761). Most patients (65%) maintained a stable weight (change ⩽5% from baseline) during the first year after OHA initiation. Those losing >5% of baseline weight had a significantly higher odds of death over the subsequent 5-years ranging from 1.64 to 2.13 depending on OHA type. In the metformin group, weight gain >5% of baseline was also associated with higher odds of 5-year mortality. The same results were obtained after conducting three sensitivity analyses that excluded patients for the following reasons: weight loss in the one year prior to OHA initiation, weight change >100lbs, or weight change >50lbs.
Weight loss was associated with higher odds of 5-year mortality among patients initiating an OHA, as was weight gain for metformin only.
在全国队列中研究2型糖尿病患者开始口服降糖药（OHA）治疗后第一年的体重变化是否与死亡率相关。
我们对退伍军人健康管理局中开始使用OHA治疗且至少一年未接受任何其他糖尿病药物治疗的2型糖尿病患者进行前瞻性随访。从电子病历中获取有关OHA、体重、合并症、其他药物、人口统计学和实验室测量的信息。使用逻辑回归来估计OHA治疗开始后第一年体重变化的5年死亡几率。
2003年至2008年间开始OHA单药治疗的患者（平均年龄65岁，97%为男性，平均BMI 32.3kg/m）共计145,198例（二甲双胍n = 89,111，格列吡嗪n = 27,100，格列本脲n = 25,226，罗格列酮n = 3,761）。大多数患者（65%）在开始使用OHA后的第一年体重保持稳定（与基线相比变化≤5%）。那些体重下降超过基线5%的患者在随后5年的死亡几率显著更高，根据OHA类型，范围在1.64至2.13之间。在二甲双胍组中，体重增加超过基线5%也与5年死亡率较高相关。在进行了三项敏感性分析后得到了相同的结果，这三项分析排除了以下原因的患者：OHA开始前一年体重下降、体重变化>100磅或体重变化>50磅。
开始使用OHA的患者中，体重减轻与5年死亡率较高相关，仅二甲双胍导致的体重增加情况也是如此。
