Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
The University of Illinois College of Medicine, Chicago, IL, USA.
Diabetes Res Clin Pract. 2018 May;139:221-229. doi: 10.1016/j.diabres.2018.02.032. Epub 2018 Mar 7.
When patients with type 2 diabetes initiate insulin, metformin should be continued while continuation of other antihyperglycemics has unclear benefit. We aimed to identify practice patterns in antihyperglycemic therapy during the insulin transition, and determine factors associated with metformin continuation.
We performed a retrospective analysis of the Look AHEAD (Action for Health in Diabetes) trial which randomized overweight/obese adults under ambulatory care for type 2 diabetes to an intensive lifestyle intervention or diabetes support and education. Among the 931 participants who initiated insulin over ten years, we described longitudinal changes in antihyperglycemic medications during the insulin transition, and performed multivariable logistic regression to estimate the association between patient characteristics and metformin continuation.
Before insulin initiation, 81.0% of patients used multiple antihyperglycemics, the most common being metformin, sulfonylureas, and thiazolidinediones. After insulin initiation, metformin was continued in 80.3% of patients; other antihyperglycemics were continued less often, yet 58.0% of patients were treated with multiple non-insulin antihyperglycemics. Metformin continuation was inversely associated with age (fully adjusted (a) OR 0.60 per 10 years [0.42-0.86]), serum creatinine above safety thresholds (aOR 0.09 [0.02-0.36]), lower income (P = 0.025 for trend), taking more medications (aOR 0.92 per medication [0.86-0.98]), and initiating rapid, short, or premixed insulin (aOR 0.59 [0.39-0.89]).
The vast majority of patients with type 2 diabetes continue metformin after insulin initiation, consistent with guidelines. Other antihyperglycemics are frequently continued along with insulin, and further research is needed to determine which, if any, patients may benefit from this.
当 2 型糖尿病患者开始使用胰岛素时，应继续使用二甲双胍，而继续使用其他降血糖药物的益处尚不清楚。我们旨在确定胰岛素转换期间降糖治疗的实践模式，并确定与二甲双胍继续使用相关的因素。
我们对 LOOK AHEAD（糖尿病中的行动）试验进行了回顾性分析，该试验将在门诊环境下接受 2 型糖尿病治疗的超重/肥胖成年人随机分为强化生活方式干预组或糖尿病支持和教育组。在十年内开始使用胰岛素的 931 名参与者中，我们描述了胰岛素转换期间降糖药物的纵向变化，并进行多变量逻辑回归估计患者特征与二甲双胍继续使用之间的关联。
在开始使用胰岛素之前，81.0%的患者使用了多种降糖药物，最常见的是二甲双胍、磺酰脲类和噻唑烷二酮类。在开始使用胰岛素后，80.3%的患者继续使用二甲双胍；其他降糖药物的使用频率较低，但仍有 58.0%的患者接受了多种非胰岛素降糖药物治疗。二甲双胍的继续使用与年龄呈负相关（完全调整后（a）OR 每 10 岁 0.60 [0.42-0.86]）、血清肌酐超过安全阈值（aOR 0.09 [0.02-0.36]）、较低的收入（趋势 P=0.025）、服用更多的药物（aOR 每增加一种药物 0.92 [0.86-0.98]）以及起始快速、短效或预混胰岛素（aOR 0.59 [0.39-0.89]）。
大多数 2 型糖尿病患者在开始使用胰岛素后继续使用二甲双胍，这与指南一致。其他降糖药物经常与胰岛素一起使用，需要进一步研究确定哪些患者可能从中受益。
