1 Department of Medicine University of Padova Italy.
2 Diabetology Service ULSS6 Cittadella Italy.
J Am Heart Assoc. 2019 Jul 16;8(14):e012244. doi: 10.1161/JAHA.119.012244. Epub 2019 Jul 4.
Background Evidence accumulated that some glucose-lowering medications protect against cardiovascular events ( CVEs ) in patients with type 2 diabetes mellitus (T2DM) and established cardiovascular disease. The present study evaluated if and how glucose-lowering medication prescription pattern changes in T2DM after a CVE. Methods and Results DATAFILE (Diabetes Therapy After a Cardiovascular Event) was a retrospective multicenter study conducted at 12 diabetes mellitus specialist outpatient clinics in Italy. We identified T2DM patients with an incident CVE for whom a follow-up visit was available after the event. We selected control T2DM patients without an incident CVE , who were matched with cases for age, sex, known diabetes mellitus duration, baseline hemoglobin A, kidney function, and follow-up time. We extracted clinical variables and compared prescribed therapies at baseline and follow-up. We included 563 patients with and 497 matched patients without an incident CVE . As expected, patients with a subsequent CVE had a higher baseline prevalence of ischemic heart disease. After a median of 9.5 months, in patients with versus those without a CVE , there was a significant increase in the prescription of beta-blockers, loop diuretics, dual antiplatelet therapy, and, among glucose-lowering medications, a significant decrease in metformin. Hemoglobin A marginally declined only in the control group, whereas low-density lipoprotein cholesterol decreased only in patients with CVE . Conclusions This study highlights that occurrence of a CVE in T2DM patients did not prime the prescription of glucose-lowering medications provided with cardiovascular protective effects, even though glucose control remained poor. These data emphasize the need to optimize the therapeutic regimen of T2DM patients with established cardiovascular disease, according to updated guidelines.
背景 有证据表明，一些降糖药物可降低 2 型糖尿病（T2DM）和已确诊心血管疾病患者的心血管事件（CVE）风险。本研究评估了 CVE 后 T2DM 患者的降糖药物处方模式是否发生变化以及如何变化。
方法和结果 DATAFILE（心血管事件后糖尿病治疗）是一项回顾性多中心研究，在意大利 12 家糖尿病专科门诊进行。我们确定了发生 CVE 的 T2DM 患者，这些患者在事件后有随访就诊。我们选择了没有发生 CVE 的 T2DM 对照患者，这些患者与病例按年龄、性别、已知糖尿病病程、基线血红蛋白 A、肾功能和随访时间匹配。我们提取了临床变量，并比较了基线和随访时的处方治疗。我们纳入了 563 例发生 CVE 的患者和 497 例匹配的无 CVE 患者。正如预期的那样，随后发生 CVE 的患者基线缺血性心脏病患病率更高。中位随访 9.5 个月后，与无 CVE 的患者相比，有 CVE 的患者β受体阻滞剂、袢利尿剂、双联抗血小板治疗的处方显著增加，而在降糖药物中，二甲双胍的处方显著减少。仅在对照组患者中血红蛋白 A 略有下降，而只有 CVE 患者的低密度脂蛋白胆固醇下降。
结论 本研究表明，T2DM 患者发生 CVE 后，并未促使使用具有心血管保护作用的降糖药物，即使血糖控制仍然不佳。这些数据强调了根据最新指南优化有明确心血管疾病的 T2DM 患者治疗方案的必要性。
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