University of Minnesota, Minneapolis, MN, United States of America.
University of Minnesota, Minneapolis, MN, United States of America.
J Diabetes Complications. 2020 Jan;34(1):107477. doi: 10.1016/j.jdiacomp.2019.107477. Epub 2019 Nov 6.
To determine which drugs were selected to be added to metformin for patients on dual anti-diabetic medication in the management of type 2 diabetes and to assess HbA1c and BMI outcomes at 6 and 12 months after the initiation of a second anti-diabetic medication.
A retrospective chart review of electronic medical record data. Second line anti-diabetic medication added to metformin between 7/1/2012 to 8/31/2017 in the primary care practice in Fairview Health System in Minnesota.
3413 patients met the selection criteria of type 2 diabetes, 18 years and older, dual anti-diabetes therapy with metformin being the first prescribed. The most frequently prescribed medications added to metformin were sulfonylurea and basal insulin accounting for 51% (1724/3413) and 37% (1268/3413) respectively. Mean HbA1c reductions at 6 and 12 months among 2134 patients with baseline and follow-up HbA1c data respectively were: GLP-1 agonist (-1.3, P < 0.001; -1.2, P < 0.001), sulfonylurea (-1.1, P < 0.001; -0.9, P < 0.001), basal insulin (-1.1, P < 0.001; -1.0, P < 0.001), DPP4 inhibitor (-0.7, P = 0.223; -0.8, P = 0.049). Patients prescribed a GLP-1 agonist had a higher mean baseline BMI (BMI =40.3 kg/m) and this was the only group with a statistically significant BMI reduction from baseline at 6 and 12 months (-1.5, P = 0.049 and -1.8, P = 0.041).
Type 2 diabetes patients treated with sulfonylurea, basal insulin and GLP-1 agonist as an add on to metformin had significant reductions in HbA1c. Patients prescribed a GLP-1 agonist had a significant BMI reduction.
确定在二甲双胍治疗 2 型糖尿病患者的基础上，添加哪些药物来治疗双联抗糖尿病药物，并评估起始二线抗糖尿病药物后 6 个月和 12 个月时的糖化血红蛋白（HbA1c）和体重指数（BMI）结果。
这是一项在明尼苏达州费尔维尤健康系统的初级保健实践中，对电子病历数据进行的回顾性图表审查。研究纳入了 2012 年 7 月 1 日至 2017 年 8 月 31 日期间，接受二甲双胍联合两种降糖药物治疗的 2 型糖尿病患者，年龄≥18 岁。
共有 3413 名患者符合研究标准，即 2 型糖尿病，年龄≥18 岁，二甲双胍联合两种降糖药物治疗，且二甲双胍是第一种开具的药物。在有基线和随访 HbA1c 数据的 2134 名患者中，分别在第 6 个月和第 12 个月时 HbA1c 均值的降低情况如下：GLP-1 激动剂（-1.3，P<0.001；-1.2，P<0.001）、磺酰脲类药物（-1.1，P<0.001；-0.9，P<0.001）、基础胰岛素（-1.1，P<0.001；-1.0，P<0.001）、DPP4 抑制剂（-0.7，P=0.223；-0.8，P=0.049）。接受 GLP-1 激动剂治疗的患者基线 BMI 更高（BMI=40.3kg/m2），但仅这一组在第 6 个月和第 12 个月时 BMI 与基线相比有统计学意义的降低（-1.5，P=0.049；-1.8，P=0.041）。
在接受二甲双胍联合磺酰脲类药物、基础胰岛素和 GLP-1 激动剂治疗的 2 型糖尿病患者中，HbA1c 显著降低。接受 GLP-1 激动剂治疗的患者 BMI 显著降低。
