Katakami Naoto, Mita Tomoya, Takahara Mitsuyoshi, Yajima Toshitaka, Wada Fumitaka, Kawashima Masaru, Shimomura Iichiro, Watada Hirotaka
Department of Metabolism and Atherosclerosis, Graduate School of Medicine, Osaka University, Osaka, Japan.
Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Diabetes Ther. 2020 Jul;11(7):1563-1578. doi: 10.1007/s13300-020-00846-6. Epub 2020 Jun 5.
J-DISCOVER aims to research the treatment reality of Japanese patients with type 2 diabetes mellitus who begin second-line treatment. Here we report baseline characteristics and factors associated with selection of second-line treatment.
J-DISCOVER is a prospective, observational, multicenter, cohort study in patients with type 2 diabetes (aged ≥ 20 years) beginning second-line treatment after first-line oral monotherapy. Baseline characteristics and treatment patterns were descriptively summarized. Logistic regression models were used to identify factors associated with specific second-line treatments.
A total of 1806 patients (mean age 61.7 years) were enrolled between September 2014 and December 2015. Mean ± standard deviation of baseline glycated hemoglobin (HbA1c) and body mass index (BMI) were 7.7 ± 1.3% and 25.5 ± 4.6 kg/m, respectively. The most prescribed medication as first-line treatment was dipeptidyl peptidase 4 inhibitors (53.7% of patients) followed by biguanides (21.4%), sulfonylureas (7.2%), and alpha-glucosidase inhibitors (6.8%). Second-line treatments included dipeptidyl peptidase 4 inhibitors (31.0%), biguanides (27.9%), sodium-glucose cotransporter 2 inhibitors (12.2%), and sulfonylureas (10.9%). First- and second-line treatments had different modes of action in 76.3% of patients. Those receiving first-line dipeptidyl peptidase 4 inhibitors were more likely to receive second-line biguanides and vice versa. Selection of second-line treatment was also associated with age, BMI, HbA1c, and renal function.
This study showed the treatment reality and factors associated with choice of second-line treatment in Japanese patients with type 2 diabetes mellitus. The choice of second-line treatment was associated with age, BMI, HbA1c, renal function, and the mode of action of the first-line treatment.
ClinicalTrials.gov NCT02226822.
J-DISCOVER旨在研究开始二线治疗的日本2型糖尿病患者的治疗现状。在此，我们报告基线特征以及与二线治疗选择相关的因素。
J-DISCOVER是一项针对2型糖尿病患者（年龄≥20岁）的前瞻性、观察性、多中心队列研究，这些患者在一线口服单药治疗后开始二线治疗。对基线特征和治疗模式进行了描述性总结。使用逻辑回归模型来确定与特定二线治疗相关的因素。
2014年9月至2015年12月期间共纳入1806例患者（平均年龄61.7岁）。基线糖化血红蛋白（HbA1c）和体重指数（BMI）的平均值±标准差分别为7.7±1.3%和25.5±4.6kg/m²。一线治疗中最常处方的药物是二肽基肽酶4抑制剂（53.7%的患者），其次是双胍类药物（21.4%）、磺脲类药物（7.2%）和α-葡萄糖苷酶抑制剂（6.8%）。二线治疗包括二肽基肽酶4抑制剂（31.0%）、双胍类药物（27.9%）、钠-葡萄糖协同转运蛋白2抑制剂（12.2%）和磺脲类药物（10.9%）。76.3%的患者一线和二线治疗的作用方式不同。接受一线二肽基肽酶4抑制剂治疗的患者更有可能接受二线双胍类药物治疗，反之亦然。二线治疗的选择还与年龄、BMI、HbA1c和肾功能有关。
本研究显示了日本2型糖尿病患者的治疗现状以及与二线治疗选择相关的因素。二线治疗的选择与年龄、BMI、HbA1c、肾功能以及一线治疗的作用方式有关。
ClinicalTrials.gov NCT02226822。
