二甲双胍的使用与 2 型糖尿病患者炎症性肠病的风险降低相关。

Metformin Use Is Associated with a Lower Risk of Inflammatory Bowel Disease in Patients with Type 2 Diabetes Mellitus.

机构信息

Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.

Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

出版信息

J Crohns Colitis. 2021 Jan 13;15(1):64-73. doi: 10.1093/ecco-jcc/jjaa136.

DOI:10.1093/ecco-jcc/jjaa136

PMID:32604412

Abstract

AIM

Our aim was to compare the risk of developing inflammatory bowel disease [IBD] between ever users and never users of metformin.

METHODS

Patients with newly diagnosed type 2 diabetes mellitus from 1999 to 2005 were enrolled from Taiwan's National Health Insurance. A total of 340 211 ever users and 24 478 never users who were free from IBD on January 1, 2006 were followed up until December 31, 2011. Hazard ratios were estimated by Cox regression incorporating the inverse probability of treatment weighting using a propensity score.

RESULTS

New-onset IBD was diagnosed in 6466 ever users and 750 never users. The respective incidence rates were 412.0 and 741.3 per 100 000 person-years and the hazard ratio for ever vs never users was 0.55 [95% confidence interval: 0.51-0.60]. A dose-response pattern was observed while comparing the tertiles of cumulative duration of metformin therapy to never users. The respective hazard ratios for the first [<26.0 months], second [26.0-58.3 months] and third [>58.3 months] tertiles were 1.00 [0.93-1.09], 0.57 [0.52-0.62] and 0.24 [0.22-0.26]. While patients treated with oral antidiabetic drugs [OADs] without metformin were treated as a reference group, the hazard ratios for patients treated with OADs with metformin, with insulin without metformin [with/without other OADs] and with insulin and metformin [with/without other OADs] were 0.52 [0.42-0.66], 0.95 [0.76-1.20] and 0.50 [0.40-0.62], respectively.

CONCLUSION

A reduced risk of IBD is consistently observed in patients with type 2 diabetes mellitus who have been treated with metformin.

摘要

目的

本研究旨在比较二甲双胍的曾用者和未用者罹患炎症性肠病（IBD）的风险。

方法

研究对象为 1999 年至 2005 年期间被诊断患有 2 型糖尿病的台湾全民健康保险参保患者。以 2006 年 1 月 1 日无 IBD 的 340211 名曾用者和 24478 名未用者为基础队列，随访至 2011 年 12 月 31 日。采用倾向性评分逆概率加权法（inverse probability of treatment weighting， IPTW），通过 Cox 回归模型计算风险比（hazard ratio，HR）。

结果

在曾用者和未用者中，分别有 6466 例和 750 例新诊断为 IBD。相应的发病率分别为 412.0 和 741.3/10 万人年，曾用者与未用者的 HR 为 0.55（95%置信区间：0.51-0.60）。在比较累积二甲双胍治疗时间的三分位与未用者的结果中，观察到剂量反应模式。第 1 个三分位（<26.0 个月）、第 2 个三分位（26.0-58.3 个月）和第 3 个三分位（>58.3 个月）的 HR 分别为 1.00（0.93-1.09）、0.57（0.52-0.62）和 0.24（0.22-0.26）。将未用二甲双胍的口服降糖药（oral antidiabetic drugs，OAD）治疗患者作为参考组，用二甲双胍治疗的 OAD 患者、未用二甲双胍的胰岛素治疗患者（伴有/不伴有其他 OAD）和用二甲双胍和胰岛素治疗的患者（伴有/不伴有其他 OAD）的 HR 分别为 0.52（0.42-0.66）、0.95（0.76-1.20）和 0.50（0.40-0.62）。