Diabetes Center, Chiba Central Medical Center, Chiba, Japan.
Department of Preventive Medicine and Public Health, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan.
J Diabetes Investig. 2021 Nov;12(11):1967-1977. doi: 10.1111/jdi.13558. Epub 2021 May 12.
AIMS/INTRODUCTION: Knowing the collective clinical factors that determine patient response to glucose-lowering medication would be beneficial in the treatment of type 2 diabetes. We carried out a retrospective cohort study to explore the combination of clinical factors involved in its therapeutic efficacy.
The results of cohort studies retrieved using the CoDiC database across Japan from January 2005 to July 2018 were analyzed based on criterion that using insulin therapy indicates severe type 2 diabetes.
A logistic regression analysis showed that age at diagnosis, disease duration, hemoglobin A1c (HbA1c) and serum C-peptide reactivity (CPR) at medication commencement were associated with the probability of insulin treatment. Receiver operating characteristic curve showed that these clinical factors predicted insulin treatment positivity with an area under the curve of >0.600. The area under the curve increased to 0.674 and 0.720 for the disease duration-to-age at diagnosis ratio and HbA1c-to-CPR ratio, respectively. Furthermore, area under the curve increased to 0.727 and 0.750 in the indices (duration-to-age ratio at diagnosis × 43 + HbA1c) and (duration-to-age ration at diagnosis × 21 + HbA1c-to-CPR ratio), respectively. After stratification to three groups according to the indices, monthly HbA1c levels during 6 months of treatment were higher in the upper one-third than in the lower one-third of patients, and many patients did not achieve the target HbA1c level (53 mmol/mol) in the upper one-third, although greater than fourfold more patients were administered insulin in the upper one-third.
The combination of disease duration-to-age at diagnosis and HbA1c-to-CPR ratios is a collective risk factor that predicts response to the medications.
目的/引言：了解决定患者对降糖药物反应的集体临床因素将有助于治疗 2 型糖尿病。我们进行了一项回顾性队列研究，以探讨其治疗效果涉及的临床因素组合。
根据使用胰岛素治疗表示 2 型糖尿病严重程度的标准，分析了 2005 年 1 月至 2018 年 7 月期间在日本使用 CoDiC 数据库检索到的队列研究结果。
逻辑回归分析表明，诊断时年龄、病程、起始药物治疗时的糖化血红蛋白（HbA1c）和血清 C 肽反应性（CPR）与胰岛素治疗的可能性相关。受试者工作特征曲线显示，这些临床因素预测胰岛素治疗阳性的曲线下面积（AUC）>0.600。病程与诊断时年龄之比和 HbA1c 与 CPR 之比的 AUC 分别增加到 0.674 和 0.720。此外，在指标（诊断时病程与年龄之比×43+HbA1c）和（诊断时病程与年龄之比×21+HbA1c 与 CPR 之比）中，AUC 分别增加到 0.727 和 0.750。根据这些指标将患者分为三组后，治疗 6 个月期间，上三分之一患者的每月 HbA1c 水平高于下三分之一患者，而上三分之一患者中许多患者未达到目标 HbA1c 水平（53mmol/mol），尽管上三分之一患者中使用胰岛素的患者数量增加了四倍以上。
病程与诊断时年龄之比和 HbA1c 与 CPR 之比的组合是预测药物反应的集体危险因素。
