Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan.
Diabetes Res Clin Pract. 2018 Apr;138:119-127. doi: 10.1016/j.diabres.2018.02.002. Epub 2018 Feb 11.
We aimed to investigate the association of difference between observed and predicted glycated hemoglobin (dopHbA1c) and HbA1c reduction after vildagliptin-based oral therapy in patients with type 2 diabetes (T2D).
This was a prospective observational study. Adults ≥ 20 years old with T2D and HbA1c ≧7% treated with oral anti-diabetic drugs (OADs) were eligible if their OADs were shifted to vildagliptin-based dual oral therapy. Fasting plasma glucose (FPG) and HbA1c were recorded at baseline, week 12, and week 24. To determine baseline dopHbA1c, a predicted HbA1c was calculated by inserting baseline FPG into a regression equation (HbA1c = FPG ∗ 0.0225 + 4.3806) developed from linear relationship between HbA1c and FPG in an independent cohort of 3239 outpatients with T2D (dopHbA1c = observed HbA1c - predicted HbA1c). Patients were assigned to low (≦0) or high (>0) dopHbA1c group according to their baseline dopHbA1c levels. The study endpoint was changes from baseline to week 24 in HbA1c levels.
A total of 1224 patients were enrolled. Patients with a dopHbA1c >0 had a greater HbA1c reduction after vildagliptin-based dual oral therapy than those with a dopHbA1c ≦0 (-1.5 ± 2.0 vs. -0.4 ± 1.0%, p < 0.001). Baseline dopHbA1c was positively associated with HbA1c reduction from baseline to week 24 (β coefficient 0.883, 95% CI 0.811 to 0.955, p < 0.001), and the association remained significant after adjustment for confounders.
In T2D patients with an HbA1c ≧7%, a higher baseline dopHbA1c was associated with a greater HbA1c reduction after shifting to vildagliptin-based dual oral therapy.
我们旨在研究接受基于维格列汀的口服治疗后，观察到的糖化血红蛋白（dopHbA1c）与预测的糖化血红蛋白（predHbA1c）之间的差异与 2 型糖尿病（T2D）患者的 HbA1c 降低之间的关联。
这是一项前瞻性观察性研究。如果符合条件的 20 岁及以上 T2D 患者，其 HbA1c≥7%，且正在接受口服降糖药物（OAD）治疗，且将 OAD 转换为基于维格列汀的双联口服治疗，则可入选。在基线、第 12 周和第 24 周记录空腹血糖（FPG）和 HbA1c。为了确定基线 dopHbA1c，通过将基线 FPG 插入从 3239 例 T2D 门诊患者的 HbA1c 与 FPG 之间的线性关系中得出的回归方程（HbA1c=FPG*0.0225+4.3806）中计算预测的 HbA1c（dopHbA1c=观察到的 HbA1c-预测的 HbA1c）。根据基线 dopHbA1c 水平，将患者分为 dopHbA1c≤0 或 dopHbA1c>0 组。研究终点为 HbA1c 水平从基线到第 24 周的变化。
共纳入 1224 例患者。与 dopHbA1c≤0 的患者相比，dopHbA1c>0 的患者接受基于维格列汀的双联口服治疗后，HbA1c 降低幅度更大（-1.5±2.0 比-0.4±1.0%，p<0.001）。基线 dopHbA1c 与从基线到第 24 周的 HbA1c 降低呈正相关（β系数 0.883，95%CI 0.811 至 0.955，p<0.001），且在调整混杂因素后仍有显著相关性。
在 HbA1c≥7%的 T2D 患者中，较高的基线 dopHbA1c 与转换为基于维格列汀的双联口服治疗后 HbA1c 降低幅度更大相关。
