Division of Nephrology, Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
BMJ Open. 2020 Feb 12;10(2):e031612. doi: 10.1136/bmjopen-2019-031612.
Patients with type 2 diabetes mellitus (T2DM) often experience hypoglycaemia and weight gain due to treatment side effects. Sulfonylureas (SU) and the combination of SU and metformin (SU+MET) were the most common monotherapy and combination therapies used in Thailand tertiary care hospitals. This study aimed to assess the glycaemic goal attainment rates, hypoglycaemic episodes, weight gain and treatment compliance among patients with T2DM receiving SU or SU+MET.
A multicentre cross-sectional survey and retrospective review was conducted in five tertiary care hospitals, Thailand. Patients with T2DM aged ≥30 years were included consecutively during a 12-month period. Glycaemic control, experiences of hypoglycaemia, weight gain and compliance were evaluated. Glycaemic goal attainment was defined by HbA level less than 7%.
Out of the 659 patients (mean age (±SD)), 65.5 (10.0) years and median duration of T2DM (IQR), 10 (5-15) years), 313 (47.5%) achieved the glycaemic goal. HbA levels in the patients with goal attainment was significantly lower compared with those without (6.3%±0.5% vs 8.1%±1.2%, p<0.001). Goal attainment was significantly lower among patients treated with SU+MET than those treated with SU alone (43.5% vs 63.0%; OR 0.45, 95% CI 0.31, 0.66, p<0.001). A third of patients reported experiencing hypoglycaemia (30.7%) and weight gain (35.4%). Weight gain in the SU+MET group was lower than those receiving SU alone (33.1% vs 44.6%, p=0.015), but there was no difference in hypoglycaemic events. Major events in the previous 12 months were experienced by 68 patients, most commonly congestive heart failure and ischaemic heart disease. Approximately half of the patients (52.2%) reported not always taking their medication as prescribed.
Among patients with T2DM receiving SU or SU+MET, only about half of the patients achieved glycaemic goal and compliance with the treatment. Hypoglycaemia and weight gain posed a significant burden with risk of weight gain higher in the SU group.
2 型糖尿病（T2DM）患者由于治疗的副作用，经常会出现低血糖和体重增加。磺酰脲类（SU）和 SU 与二甲双胍的联合治疗（SU+MET）是泰国三级保健医院最常用的单药和联合治疗药物。本研究旨在评估接受 SU 或 SU+MET 治疗的 T2DM 患者的血糖控制达标率、低血糖发作、体重增加和治疗依从性。
这是一项在泰国五家三级保健医院进行的多中心横断面调查和回顾性研究。在 12 个月期间连续纳入年龄≥30 岁的 T2DM 患者。评估血糖控制、低血糖发作、体重增加和依从性。血糖控制达标定义为 HbA 水平＜7%。
在 659 名患者中（平均年龄（±SD），65.5（10.0）岁，中位 T2DM 病程（IQR），10（5-15）年），313 名（47.5%）患者达到了血糖控制目标。与未达到目标的患者相比，达到目标的患者 HbA 水平显著降低（6.3%±0.5%比 8.1%±1.2%，p＜0.001）。与单独使用 SU 相比，联合使用 SU+MET 的患者达到血糖控制目标的比例显著更低（43.5%比 63.0%；OR 0.45，95%CI 0.31，0.66，p＜0.001）。三分之一的患者报告有低血糖（30.7%）和体重增加（35.4%）。与单独使用 SU 的患者相比，SU+MET 组的体重增加较低（33.1%比 44.6%，p=0.015），但低血糖事件无差异。在过去 12 个月中有 68 名患者经历了主要事件，最常见的是充血性心力衰竭和缺血性心脏病。大约一半的患者（52.2%）报告没有按照规定服药。
在接受 SU 或 SU+MET 治疗的 T2DM 患者中，只有约一半的患者达到了血糖控制目标和治疗依从性。低血糖和体重增加带来了显著的负担，SU 组体重增加的风险更高。
