Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia.
Diabetes Care. 2018 Jan;41(1):69-78. doi: 10.2337/dc17-1414. Epub 2017 Nov 6.
To explore temporal trends in antidiabetes drug (ADD) prescribing and intensification patterns, along with glycemic levels and comorbidities, and possible benefits of novel ADDs in delaying the need for insulin initiation in patients diagnosed with type 2 diabetes.
Patients with type 2 diabetes aged 18-80 years, who initiated any ADD, were selected ( = 1,023,340) from the U.S. Centricity Electronic Medical Records. Those who initiated second-line ADD after first-line metformin were identified (subcohort 1, = 357,482); the third-line therapy choices were further explored.
From 2005 to 2016, first-line use increased for metformin (60-77%) and decreased for sulfonylureas (20-8%). During a mean follow-up of 3.4 years post metformin, 48% initiated a second ADD at a mean HbA of 8.4%. In subcohort 1, although sulfonylurea usage as second-line treatment decreased (60-46%), it remained the most popular second ADD choice. Use increased for insulin (7-17%) and dipeptidyl peptidase-4 inhibitors (DPP-4i) (0.4-21%). The rates of intensification with insulin and sulfonylureas did not decline over the last 10 years. The restricted mean time to insulin initiation was marginally longer in second-line DPP-4i (7.1 years) and in the glucagon-like peptide 1 receptor agonist group (6.6 years) compared with sulfonylurea (6.3 years, < 0.05).
Most patients initiate second-line therapy at elevated HbA levels, with highly heterogeneous clinical characteristics across ADD classes. Despite the introduction of newer therapies, sulfonylureas remained the most popular second-line agent, and the rates of intensification with sulfonylureas and insulin remained consistent over time. The incretin-based therapies were associated with a small delay in the need for therapy intensification compared with sulfonylureas.
探讨抗糖尿病药物（ADD）处方和强化模式的时间趋势，以及血糖水平和合并症，以及新型 ADD 在延迟 2 型糖尿病患者开始胰岛素治疗方面的可能益处。
从美国 Centricity 电子病历中选择了年龄在 18-80 岁之间的任何 ADD 起始患者（=1023340 人）。确定了在一线二甲双胍后开始二线 ADD 的患者（亚组 1，=357482 人）；进一步探讨了三线治疗选择。
从 2005 年到 2016 年，一线使用二甲双胍的比例增加（60-77%），而磺酰脲类药物的使用比例减少（20-8%）。在二甲双胍治疗后平均 3.4 年的随访中，48%的患者在平均 HbA 为 8.4%时开始使用第二种 ADD。在亚组 1 中，虽然二线治疗中磺酰脲类药物的使用减少（60-46%），但它仍然是最受欢迎的二线 ADD 选择。胰岛素（7-17%）和二肽基肽酶-4 抑制剂（DPP-4i）（0.4-21%）的使用增加。在过去 10 年中，胰岛素和磺酰脲类药物的强化率没有下降。与磺酰脲类药物（6.3 年，<0.05）相比，二线 DPP-4i（7.1 年）和胰高血糖素样肽 1 受体激动剂组（6.6 年）的胰岛素起始限制平均时间略有延长。
大多数患者在 HbA 水平升高时开始二线治疗，不同 ADD 类别之间的临床特征高度异质。尽管引入了新的疗法，但磺酰脲类药物仍然是最受欢迎的二线药物，而且随着时间的推移，磺酰脲类药物和胰岛素的强化率保持不变。与磺酰脲类药物相比，基于肠促胰岛素的治疗与需要强化治疗的时间延迟略有相关。
