Cigrovski Berković Maja, Herman Mahečić Davorka, Gradišer Marina, Bilić-Ćurčić Ines
Department for Endocrinology, Diabetes and Metabolism, University Hospital Centre "Sestre milosrdnice", Zagreb, Croatia.
Department for Endocrinology, Diabetes and Metabolism, University Hospital Centre "Sestre milosrdnice", Zagreb, Croatia.
Prim Care Diabetes. 2017 Jun;11(3):265-272. doi: 10.1016/j.pcd.2017.02.004. Epub 2017 Mar 15.
We assessed the impact of clinical practice and health policy on the choice and efficacy of different second-line therapies for the treatment of type 2 diabetes (T2DM) after failure of metformin.
This retrospective database analysis included 200 patients with a follow-up period of 6 months. The primary end-point was achievement of HbA1c <7% and fasting (FBG) and postprandial glucose levels (PPG) <7.2mmol/L and <10mmol/L, respectively after three and six months of different add-on treatments. Secondary end-points were weight change during treatment and incidence of hypoglycemia.
All second-line therapeutic options, except human basal insulin (BHI) and thiazolidendions (TZD) significantly increased the proportion of patients reaching target HbA1c after 6 months (p<0.01). Only sulfonylurea (SU) and dipeptidyl peptidase-4 (DPP-4) inhibitors significantly reduced all monitored parameters of glucoregulation without changing body weight and BMI after 3 and 6 months as opposed to insulin agents. However, there were no statistically significant differences between the groups when adjusting for starting HbA1c, FBG and PPG (F=1.16, p=NS), although a statistically significant difference in HbA1c levels (F=3.35, p<0.01) persisted in DPP-4 inhibitor users. The incidence of hypoglycemia was significantly higher in patients treated with NPH insulin and premixed insulin than in patients treated with other agents.
A more aggressive approach is needed with early treatment intensification using available agents.
我们评估了临床实践和卫生政策对二甲双胍治疗失败后2型糖尿病（T2DM）不同二线治疗方案的选择和疗效的影响。
这项回顾性数据库分析纳入了200例患者，随访期为6个月。主要终点是在不同的联合治疗3个月和6个月后，糖化血红蛋白（HbA1c）<7%以及空腹血糖（FBG）和餐后血糖水平（PPG）分别<7.2mmol/L和<10mmol/L的达成情况。次要终点是治疗期间的体重变化和低血糖发生率。
除人基础胰岛素（BHI）和噻唑烷二酮类（TZD）外，所有二线治疗方案在6个月后均显著提高了达到目标HbA1c的患者比例（p<0.01）。与胰岛素制剂相比，仅磺脲类（SU）和二肽基肽酶-4（DPP-4）抑制剂在3个月和6个月后显著降低了所有监测的血糖调节参数，且未改变体重和体重指数（BMI）。然而，在调整起始HbA1c、FBG和PPG后，各组之间无统计学显著差异（F=1.16，p=无显著性差异），尽管DPP-4抑制剂使用者的HbA1c水平仍存在统计学显著差异（F=3.35，p<0.01）。使用中效胰岛素（NPH）和预混胰岛素治疗的患者低血糖发生率显著高于使用其他药物治疗的患者。
需要采用更积极的方法，早期强化使用现有药物进行治疗。
