Obesity and Endocrinology Research Group, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom.
AstraZeneca, Luton, United Kingdom.
Diabetes Res Clin Pract. 2019 Sep;155:107791. doi: 10.1016/j.diabres.2019.107791. Epub 2019 Jul 17.
Early treatment intensification for type 2 diabetes mellitus (T2DM) is often required to achieve glycaemic control and avoid longer-term complications. We assessed associations between early versus later dapagliflozin initiation with changes in glucose control, weight, and blood pressure using UK Clinical Practice Research Datalink (CPRD) data.
People with T2DM aged ≥18 years, initiating dapagliflozin between November 2012 and August 2016 and with prior oral T2DM therapy (N = 3774), were included. The relationship between early (first intensification after metformin or sulfonylurea monotherapy) and later (second or higher-order intensification) dapagliflozin use and baseline changes in glycated haemoglobin A1c (HbA1c; ≥1.0% absolute reduction), weight (≥5.0% relative loss), and systolic blood pressure (SBP; ≥2 mmHg absolute reduction) after 6-12 months were assessed.
Overall, 25% of patients (951 of 3774) were early users and 75% (2823 of 3774) were later users. Later users were older, more likely to be men, and had longer disease duration. Early and later users had similar baseline mean HbA1c levels. For early versus later users, respectively, baseline-adjusted mean (95% confidence interval [CI]) reductions were 1.54% (-1.65, -1.44) versus 1.02% (-1.08, -0.97) in HbA1c, 3.31% (-4.37, -2.25) versus 4.06% (-5.05, -3.07) in weight, and 2.50 mm Hg (-3.89, -1.11) versus 2.84 mm Hg (-3.67, -2.01) in SBP. Early versus later use was associated with a greater likelihood of adjusted HbA1c reduction of ≥1% (odds ratio: 1.68, 95% CI: 1.15-2.45).
Glycaemic benefits were greater with early versus later dapagliflozin intensification. These results support broader and earlier dapagliflozin use.
2 型糖尿病（T2DM）常需早期强化治疗以控制血糖并避免长期并发症。我们使用英国临床实践研究数据库（CPRD）数据评估了早期与晚期达格列净起始治疗与血糖控制、体重和血压变化之间的相关性。
纳入 2012 年 11 月至 2016 年 8 月期间起始达格列净治疗且年龄≥18 岁、有 T2DM 前期口服药物治疗史（N=3774）的患者。评估早期（二甲双胍或磺酰脲单药治疗后首次强化治疗）与晚期（第二次或更高序次强化治疗）达格列净使用与 6-12 个月后糖化血红蛋白 A1c（HbA1c；绝对降幅≥1.0%）、体重（相对降幅≥5.0%）和收缩压（SBP；绝对降幅≥2mmHg）的基线变化之间的关系。
总体而言，25%（951/3774）的患者为早期使用者，75%（2823/3774）为晚期使用者。晚期使用者年龄更大，更可能为男性，且疾病病程更长。早期和晚期使用者的基线平均 HbA1c 水平相似。对于早期与晚期使用者，HbA1c 的基线调整后平均（95%置信区间[CI]）降幅分别为 1.54%（-1.65，-1.44）与 1.02%（-1.08，-0.97）、体重分别为 3.31%（-4.37，-2.25）与 4.06%（-5.05，-3.07）、SBP 分别为 2.50mmHg（-3.89，-1.11）与 2.84mmHg（-3.67，-2.01）。与晚期相比，早期使用达格列净与 HbA1c 降幅≥1%的调整可能性更大（比值比：1.68，95%CI：1.15-2.45）。
与晚期相比，早期达格列净强化治疗的血糖获益更大。这些结果支持更广泛和更早地使用达格列净。
