Eliasson Björn, Ekelund Jan, Amberntsson Rikard, Miftaraj Mervete, Svensson Ann-Marie
Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
National Diabetes Register, Centre of Registers, Gothenburg, Sweden.
Diabetes Ther. 2019 Aug;10(4):1523-1530. doi: 10.1007/s13300-019-0632-4. Epub 2019 May 14.
Were the participants of the EMPA-REG OUTCOME trial representative of patients receiving empagliflozin in clinical practice? The aim of the present study was to examine the prevalence of cardiovascular disease (CVD) in type 2 diabetes patients starting empagliflozin treatment in routine clinical practice in Sweden.
We used nationwide data from the Swedish National Diabetes Register (NDR), the Swedish Prescribed Drug Register, and the Swedish National Patient Register to provide clinical characteristics and ongoing treatments.
The total study cohort included 460,558 patients, of whom 130,508 (28.3%) had a history of CVD. The number of patients starting empagliflozin during the study period was 16,985. Among these, 1952 (11.5%) had a history of CVD. The patients starting empagliflozin were younger than the total cohort and were more likely to have retinopathy despite having a similar duration of diabetes to the overall cohort. They also exhibited higher BMI, HbA1c, and eGFR, and were more likely to be treated with insulin and lipid-lowering and blood-pressure-lowering medications. The patients with CVD who were starting empagliflozin were slightly older and had been diabetic for slightly longer than the patients without CVD who were starting empagliflozin, but they also had lower eGFR. Among the patients with CVD who were starting empagliflozin, 87% had coronary heart disease, 8% had suffered a stroke, 13% had peripheral artery disease, 16% had atrial fibrillation, and 20% had congestive heart failure.
The prevalence of CVD in patients with type 2 diabetes in clinical practice in Sweden was 28.3% during the study period, and it was 11.5% in the patients starting empagliflozin treatment. Patients of the latter cohort were, however, younger, more obese, and more likely to have unsatisfactory glycemic control, requiring additional treatment. Overall, a large proportion of type 2 diabetes patients should be considered at high cardiovascular risk.
Boehringer Ingelheim AB, Sweden.
EMPA-REG OUTCOME试验的参与者能否代表临床实践中接受恩格列净治疗的患者？本研究旨在调查瑞典常规临床实践中开始接受恩格列净治疗的2型糖尿病患者的心血管疾病（CVD）患病率。
我们使用了来自瑞典国家糖尿病登记处（NDR）、瑞典处方药登记处和瑞典国家患者登记处的全国性数据，以提供临床特征和正在进行的治疗信息。
整个研究队列包括460,558名患者，其中130,508名（28.3%）有CVD病史。研究期间开始使用恩格列净的患者有16,985名。其中，1952名（11.5%）有CVD病史。开始使用恩格列净的患者比整个队列更年轻，尽管糖尿病病程与整个队列相似，但更有可能患有视网膜病变。他们还表现出更高的体重指数、糖化血红蛋白和估算肾小球滤过率，并且更有可能接受胰岛素、降脂和降压药物治疗。开始使用恩格列净的CVD患者比未患CVD且开始使用恩格列净的患者年龄稍大，糖尿病病程稍长，但估算肾小球滤过率也较低。在开始使用恩格列净的CVD患者中，87%患有冠心病，8%曾患中风，13%患有外周动脉疾病，16%患有心房颤动，20%患有充血性心力衰竭。
在研究期间，瑞典临床实践中2型糖尿病患者的CVD患病率为28.3%，开始接受恩格列净治疗的患者中这一比例为11.5%。然而，后一组患者更年轻、更肥胖，血糖控制情况更不理想，需要额外治疗。总体而言，应将很大一部分2型糖尿病患者视为心血管疾病高危人群。
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