非肥胖和肥胖 2 型糖尿病合并冠心病患者的血糖控制策略。

Strategies for glycemic control in nonobese and obese type 2 diabetic patients with coronary artery disease.

机构信息

Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.

出版信息

Int J Cardiol. 2019 May 1;282:1-6. doi: 10.1016/j.ijcard.2019.02.008. Epub 2019 Feb 7.

DOI:10.1016/j.ijcard.2019.02.008

PMID:30772014

Abstract

BACKGROUND

This study aimed to assess strategies of insulin-providing (IP) or insulin-sensitizing (IS) therapy for glycemic control in nonobese diabetic patients with coronary artery disease (CAD) with possibly higher cardiovascular risk and lower insulin secretion than obese diabetic patients with CAD.

METHODS

We used data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial to calculate hazard ratio (HR) with 95% confidence interval (95%CI) for outcome events in patients with type 2 diabetes and CAD using Cox proportional hazard models. The comparison between the IP and IS groups was performed using the randomized design of the BARI 2D trial separately for nonobese (n = 1021) and obese (n = 1319) patients. The primary outcome was a composite endpoint including all-cause death, myocardial infarction, and stroke.

RESULTS

During the follow-up, 231 nonobese and 295 obese patients had one confirmed primary outcome event. In nonobese patients, the risk of primary outcome events was significantly higher in the IP group than the IS group (HR: 1.30, 95%CI: 1.00-1.68, P = 0.04), whereas that in obese patients did not differ significantly between the two groups. Moreover, in nonobese patients, the risk of primary outcome events in those without abdominal obesity was significantly higher in the IP group than that in the IS group (HR: 1.51, 95%CI: 1.05-2.19, P = 0.02). There were no significant interactions between the strategy for glycemic control and various subgroups of nonobese patients.

CONCLUSIONS

In nonobese patients with type 2 diabetes and CAD, the IS treatment strategy may be more beneficial than the IP treatment strategy.

摘要

背景

本研究旨在评估胰岛素提供（IP）或胰岛素增敏（IS）治疗策略对非肥胖型糖尿病合并冠心病（CAD）患者的血糖控制效果，这些患者的心血管风险可能高于肥胖型糖尿病合并 CAD 患者，且胰岛素分泌功能可能更低。

方法

我们使用 Bypass Angioplasty Revascularization Investigation 2 Diabetes（BARI 2D）试验的数据，通过 Cox 比例风险模型计算了 2 型糖尿病合并 CAD 患者的风险比（HR）及其 95%置信区间（95%CI），以评估结局事件。非肥胖（n=1021）和肥胖（n=1319）患者分别采用 BARI 2D 试验的随机设计，对 IP 组和 IS 组进行比较。主要结局包括全因死亡、心肌梗死和卒中等复合终点事件。

结果

随访期间，非肥胖组有 231 例患者和肥胖组有 295 例患者发生了 1 例确认的主要结局事件。在非肥胖患者中，IP 组的主要结局事件风险明显高于 IS 组（HR：1.30，95%CI：1.00-1.68，P=0.04），而肥胖患者中两组间无显著差异。此外，在非肥胖患者中，无腹型肥胖的患者中，IP 组的主要结局事件风险明显高于 IS 组（HR：1.51，95%CI：1.05-2.19，P=0.02）。血糖控制策略与非肥胖患者的各种亚组之间无显著交互作用。