Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China.
BMJ Open. 2018 Nov 21;8(11):e024909. doi: 10.1136/bmjopen-2018-024909.
To assess whether the use of multiple antidiabetic medications is associated with an increased risk of hypoglycaemia in patients with type 2 diabetes mellitus.
A case-crossover study.
Cases were enrolled from the National Center for Diabetes, Endocrinology and Genetics in Amman, Jordan.
Patients were those with diabetes mellitus and reported incident of a hypoglycaemic event in their medical records during the period January 2007 to July 2017. Patients with multiple antidiabetic medications were those with at least two antidiabetic medications.
History of antidiabetic medication use was extracted from the pharmacy records. The use of multiple antidiabetic medications during the risk window (before hypoglycaemia) was compared with a control window(s) (earlier time) of the same length after a washout period. Conditional logistic regression was applied to evaluate the OR of hypoglycaemia between the treatment groups. A secondary analysis was performed in patients with a blood glucose measurement of ≤70 mg/dL.
182 patients (106 females, 58.2%) were included in the study with an average age of 59.9 years (SD=9.9). The patients' average body mass index was 31.7 kg/m (SD=6.2). Compared with monotherapy, the OR of hypoglycaemic events for patients with multiple antidiabetic medications was 5.00 (95% CI 1.10 to 22.82). The OR was 6.00 (95% CI 0.72 to 49.84) for the secondary analysis patient group (n=94). Ten-fold increased risk was found in patients (n=155) with insulin and sulfonylurea-based combination therapy (OR 10.00;95% CI 1.28 to 78.12).
This study shows that the use of multiple antidiabetic medications appears to increase the risk of hypoglycaemic events. Patients and healthcare professionals should be extra vigilant when patients are on multiple antidiabetic medications therapy, especially the combination of sulfonylurea and insulin.
评估 2 型糖尿病患者使用多种降糖药物是否会增加低血糖风险。
病例交叉研究。
病例来自约旦安曼的国家糖尿病、内分泌和遗传学中心。
患者为糖尿病患者，病历中报告了 2007 年 1 月至 2017 年 7 月期间发生低血糖事件。使用多种降糖药物的患者至少使用了两种降糖药物。
从药房记录中提取降糖药物使用史。在洗脱期后，将风险窗口（低血糖发生前）期间的多种降糖药物使用与相同长度的对照窗口（较早时间）进行比较。应用条件逻辑回归评估治疗组之间低血糖的比值比（OR）。进行了次要分析，以评估血糖测量值≤70mg/dL 的患者。
共纳入 182 例患者（106 例女性，58.2%），平均年龄为 59.9 岁（标准差[SD]=9.9）。患者平均体重指数为 31.7kg/m（SD=6.2）。与单药治疗相比，使用多种降糖药物的患者发生低血糖事件的 OR 为 5.00（95%置信区间 1.10 至 22.82）。对次要分析患者组（n=94），OR 为 6.00（95%置信区间 0.72 至 49.84）。在接受胰岛素和磺酰脲类联合治疗的患者（n=155）中发现，风险增加了 10 倍（OR 10.00；95%置信区间 1.28 至 78.12）。
本研究表明，使用多种降糖药物似乎会增加低血糖事件的风险。当患者接受多种降糖药物治疗时，特别是磺酰脲类和胰岛素联合治疗时，患者和医疗保健专业人员应格外警惕。
