LMC Diabetes & Endocrinology, Brampton, Ontario, Canada.
Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada.
Diabetes Obes Metab. 2018 Jan;20(1):195-199. doi: 10.1111/dom.13040. Epub 2017 Jul 31.
This study investigates changes in A1C following a switch from dual therapy of metformin and DPP-4 inhibitor to a fixed-dose combination (FDC) of metformin + DPP-4 inhibitor following the introduction of the FDC in the provincial formulary. The LMC Diabetes Registry was queried retrospectively for patients with type 2 diabetes, aged between 18 and 80 years with at least one A1C recorded prior and ≥3 months post-switch. Five hundred and sixty-eight subjects with mean age 64 ± 12 years and mean A1C 7.7% ± 1.2% met study criteria. Overall, A1C was 0.3% lower post-switch to FDC (P < .01). In stratified analysis, subjects with baseline A1C between 7% and 10% had 0.4% lower A1C (P < .01), with 31% of these subjects reaching target A1C ≤7%, post-switch. A1C reduction was greater among patients with a higher baseline pill burden: 0.4% among those using ≥10 pills/day vs. 0.1% for those with <10 pills/day (P = .02). In this real-world study, switching to FDC of metformin + DPP-4 inhibitor was associated with a significant improvement in A1C. Switching to FDC, especially in patients with high pill burden, can improve A1C goal achievement in clinical practice.
本研究调查了在省级处方中引入固定剂量复方（FDC）后，从二甲双胍和 DPP-4 抑制剂的双联疗法转换为 FDC 的情况下，A1C 的变化。通过 LMC 糖尿病登记处进行回顾性查询，纳入年龄在 18 至 80 岁之间、至少有一次 A1C 记录且转换后≥3 个月的 2 型糖尿病患者。共有 568 名符合条件的受试者，平均年龄 64±12 岁，平均 A1C 7.7%±1.2%。总体而言，转换为 FDC 后 A1C 降低了 0.3%（P<.01）。分层分析显示，A1C 基线在 7%至 10%之间的受试者 A1C 降低了 0.4%（P<.01），其中 31%的受试者达到了≤7%的目标 A1C。基线药物负担较高的患者 A1C 降低幅度更大：每天使用≥10 片的患者降低 0.4%，每天使用<10 片的患者降低 0.1%（P=0.02）。在这项真实世界研究中，转换为 FDC 的二甲双胍+DPP-4 抑制剂与 A1C 的显著改善相关。在临床实践中，转换为 FDC，尤其是在药物负担较高的患者中，可以提高 A1C 达标率。
