Heilig-Geist Hospital Bensheim, Abteilung für Gastroenterologie und Diabetologie, Rodensteinstrasse 94, 64625, Bensheim, Germany.
Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany.
Acta Diabetol. 2020 Feb;57(2):229-236. doi: 10.1007/s00592-019-01409-3. Epub 2019 Aug 30.
Our study aimed to analyse treatment strategies after failure of initial metformin mono-therapy in adult patients with type-2 diabetes (T2DM).
The DIVE and DPV databases were combined and 16,681 adult patients with T2DM and metformin mono-therapy identified. Patients were analysed depending on whether metformin was continued (MET), or whether it was combined with other oral antidiabetics (OAD), with GLP-1 antagonists (GLP-1) or with basal insulin (BOT/BOT plus). Metabolic control, body weight and hypoglycaemia, micro- and macro-vascular events were compared within 1 year.
A total of 11,911 (71%) participants continued MET until the end of the observation period, 3334 (20.0%) were intensified using OAD, 579 (3%) started on GLP-1, and 857 (5%) were initiated on BOT/BOTplus. Predictors of OAD and BOT/BOTplus therapy were elevated HbA1c, longer diabetes duration and the presence of micro- and macro-vascular diseases, while GLP-1 therapy was predicted by younger age, female sex, higher body weight and shorter diabetes duration. Micro- and macro-vascular diseases were negative predictors of GLP-1 therapy. Effects on HbA1c were highest in the BOT/BOTplus and OAD group, while GLP-1 treatment had the best effect on body weight.
BOT/BOTplus and OAD show good HbA1c reduction even in patients with longer diabetes duration and in older patients. GLP-1 therapy is effective concerning weight loss in overweight patients and is more often used in females and patients with shorter diabetes duration. Interestingly, despite several studies showing positive effects on micro- and macro-vascular outcomes, prevalent macro-vascular diseases are no predictors of GLP-1 use.
本研究旨在分析二甲双胍初始单药治疗失败后成年 2 型糖尿病（T2DM）患者的治疗策略。
合并 DIVE 和 DPV 数据库，共纳入 16681 例接受二甲双胍单药治疗的 T2DM 成年患者。根据是否继续使用二甲双胍（MET）、联合其他口服降糖药（OAD）、GLP-1 拮抗剂（GLP-1）或基础胰岛素（BOT/BOT 联合），对患者进行分析。比较 1 年内的代谢控制、体重和低血糖、微血管和大血管事件。
共有 11911 例（71%）患者在观察期结束时继续使用 MET，3334 例（20.0%）患者接受 OAD 强化治疗，579 例（3%）患者开始使用 GLP-1，857 例（5%）患者开始使用 BOT/BOT 联合治疗。OAD 和 BOT/BOT 联合治疗的预测因素是 HbA1c 升高、糖尿病病程较长以及存在微血管和大血管疾病，而 GLP-1 治疗的预测因素是年龄较小、女性、体重较高和糖尿病病程较短。微血管和大血管疾病是 GLP-1 治疗的负面预测因素。BOT/BOT 联合和 OAD 组对 HbA1c 的影响最大，而 GLP-1 治疗对体重的影响最好。
BOT/BOT 联合和 OAD 即使在糖尿病病程较长和老年患者中，也能有效降低 HbA1c。GLP-1 治疗对超重患者体重减轻有效，且更多用于女性和糖尿病病程较短的患者。有趣的是，尽管多项研究表明 GLP-1 对微血管和大血管结局有积极影响，但大血管疾病的普遍存在并不是 GLP-1 应用的预测因素。
