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德谷胰岛素与甘精胰岛素在初治2型糖尿病患者中的疗效及安全性比较:一项多国随机对照试验的中国队列研究结果

[The efficacy and safety of insulin degludec versus insulin glargine in insulin-naive subjects with type 2 diabetes: results of a Chinese cohort from a multinational randomized controlled trial].

作者信息

Mu Y M, Guo L X, Li L, Li Y M, Xu X J, Li Q M, Xu M T, Zhu L Y, Yuan G Y, Liu Y, Xu C, Wang Z J, Shen F X, Luo Y, Liu J Y, Li Q F, Wang W H, Lai X Y, Xu H F, Pan C Y

机构信息

Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China.

出版信息

Zhonghua Nei Ke Za Zhi. 2017 Sep 1;56(9):660-666. doi: 10.3760/cma.j.issn.0578-1426.2017.09.008.

Abstract

To compare the safety and efficacy of insulin degludec (IDeg) with those of insulin glargine (IGlar) in insulin-naive subjects with type 2 diabetes (T2DM). This was a 26-week, randomized, open-label, parallel-group, treat-to-target trial in 560 Chinese subjects with T2DM (men/women: 274/263, mean age 56 years, mean diabetes duration 7 years) inadequately controlled on oral antidiabetic drugs (OADs). Subjects were randomized 2∶1 to once-daily IDeg (373 subjects) or IGlar(187 subjects), both in combination with metformin. The primary endpoint was changes from baseline in glycosylated hemoglobin(HbA1c) after 26 weeks. Mean HbA1c decreased from 8.2% in both groups to 6.9% in IDeg and 7.0% in IGlar, respectively. Estimated treatment difference (ETD) of IDeg-IGlar in change from baseline was -0.10% points (95%-0.25-0.05). The proportion of subjects achieving HbA1c<7.0% was 56.3%and 49.7% with IDeg and IGlar, respectively [estimated odds ratio of IDeg/IGlar: 1.26(95% 0.88-1.82)]. Numerically lower rateof overall confirmed hypoglycaemia and statistically significantly lower nocturnal confirmed hypoglycemia were associated with IDeg compared with IGlar, respectively [estimated rateratio of IDeg/IGlar 0.69(95% 0.46-1.03), and 0.43(95% 0.19-0.97)]. No differences in other safety parameters were found between the two groups. IDeg was non-inferior to IGlar in terms of glycaemic control, and was associated with a statistically significantly lower rate of nocturnal confirmed hypoglycaemia. IDeg is considered to be suitable for initiating insulin therapy in Chinese T2DM patients on OADs requiring intensified treatment. Clinicaltrials.gov, NCT01849289.

摘要

比较德谷胰岛素(IDeg)与甘精胰岛素(IGlar)在初治2型糖尿病(T2DM)患者中的安全性和有效性。这是一项为期26周的随机、开放标签、平行组、达标治疗试验,纳入560例口服降糖药(OADs)控制不佳的中国T2DM患者(男性/女性:274/263,平均年龄56岁,平均糖尿病病程7年)。受试者按2∶1随机分为每日一次IDeg组(373例)或IGlar组(187例),两组均联合二甲双胍。主要终点为26周后糖化血红蛋白(HbA1c)相对于基线的变化。两组的平均HbA1c分别从8.2%降至IDeg组的6.9%和IGlar组的7.0%。IDeg - IGlar相对于基线变化的估计治疗差异(ETD)为 -0.10个百分点(95%可信区间 -0.25至 -0.05)。HbA1c<7.0%的受试者比例在IDeg组和IGlar组分别为56.3%和49.7%[IDeg/IGlar的估计比值比:1.26(95%可信区间0.88至1.82)]。与IGlar相比,IDeg的总体确诊低血糖发生率在数值上较低,夜间确诊低血糖发生率在统计学上显著更低[IDeg/IGlar的估计发生率比值分别为0.69(95%可信区间0.46至1.03)和0.43(95%可信区间0.19至0.97)]。两组在其他安全参数方面未发现差异。在血糖控制方面,IDeg不劣于IGlar,且夜间确诊低血糖发生率在统计学上显著更低。IDeg被认为适用于对需要强化治疗的OADs治疗的中国T2DM患者起始胰岛素治疗。Clinicaltrials.gov,NCT01849289。

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