Tan Xi, Yang Lingfeng, Khunti Kamlesh, Zhang Ruya, Zhang Ye, Rajpathak Swapnil, Yu Miao
Merck & Co., Inc., Kenilworth, New Jersey, USA.
Diabetes Research Centre, University of Leicester, Leicester, UK.
Diabetes Obes Metab. 2021 Oct;23(10):2251-2260. doi: 10.1111/dom.14466. Epub 2021 Jul 6.
Studies examining the prevalence of and factors associated with switching from sulphonylureas (SUs) to dipeptidyl peptidase 4 (DPP-4) inhibitors in real-world settings are lacking. We assessed the factors associated with switching from SUs to DPP-4 inhibitors in the United States.
This retrospective cohort study was conducted using the Optum Clinformatics® Data Mart (2009-2018). Adults with type 2 diabetes and newly prescribed at least two SUs were included and were followed for 2 years after the initiation of SU (index date). We compared the characteristics of those who switched from SUs to DPP-4 inhibitors (only; no additional antidiabetic drugs) with those who continued with SUs (without adding other antidiabetic drugs) using multivariate logistic regression. Multinomial regression analyses were also conducted to assess the factors associated with switching to different drug classes versus continuation with SUs.
In a sample of 119 107 new SU users, 2.2% (2633) switched to DPP-4 inhibitors, 3.8% (4542) switched to antidiabetic drugs other than DPP-4 inhibitors, 68.3% (81 394) discontinued SUs but did not switch to another antidiabetic drug, 12.9% (15 345) continued with SUs and added other antidiabetic drugs, and 12.8% (15 193) continued with SUs only. Multivariate logistic regression showed that those who had significantly higher likelihood of switching were younger, female [vs. males; adjusted odds ratio (AOR) = 0.70], and living in the south; had previous use of DPP-4 inhibitors (AOR = 1.71); were not using antidiabetic drugs at baseline; had more baseline diabetes-related emergency room visits (AOR = 1.13), depression (AOR = 1.34), post-index hypoglycaemia (AOR = 2.20), and an earlier index year; and were glyburide users (vs. glimepiride users; AOR = 1.29).
The discontinuation rate for SUs is high. Factors associated with switching from SUs to DPP-4 inhibitors included age, sex, geographic region, baseline antidiabetic drug use, type of SU, baseline diabetes-related emergency room visits, hypoglycaemia and depression.
缺乏在现实环境中研究从磺脲类药物（SUs）转换为二肽基肽酶4（DPP-4）抑制剂的患病率及相关因素的研究。我们评估了美国从SUs转换为DPP-4抑制剂的相关因素。
本回顾性队列研究使用Optum Clinformatics®数据集市（2009 - 2018年）进行。纳入患有2型糖尿病且新开具至少两种SUs的成年人，并在开始使用SU（索引日期）后随访2年。我们使用多因素逻辑回归比较了从SUs转换为DPP-4抑制剂（仅转换；无其他抗糖尿病药物）的患者与继续使用SUs（未添加其他抗糖尿病药物）的患者的特征。还进行了多项回归分析，以评估与转换至不同药物类别而非继续使用SUs相关的因素。
在119107名新使用SU的样本中，2.2%（2633人）转换为DPP-4抑制剂，3.8%（4542人）转换为除DPP-4抑制剂之外的抗糖尿病药物，68.3%（81394人）停用SU但未转换至另一种抗糖尿病药物，12.9%（15345人）继续使用SU并添加其他抗糖尿病药物，12.8%（15193人）仅继续使用SU。多因素逻辑回归显示，转换可能性显著更高的患者更年轻、为女性（与男性相比；调整优势比[AOR]=0.70）且居住在南部；既往使用过DPP-4抑制剂（AOR = 1.71）；基线时未使用抗糖尿病药物；基线时糖尿病相关急诊就诊次数更多（AOR = 1.13）、有抑郁症（AOR =1.34）、索引日期后发生低血糖（AOR = 2.20）且索引年份更早；并且是使用格列本脲的患者（与使用格列美脲的患者相比；AOR = 1.29）。
SU的停药率很高。从SUs转换为DPP-4抑制剂的相关因素包括年龄、性别、地理区域、基线抗糖尿病药物使用情况、SU类型、基线糖尿病相关急诊就诊次数、低血糖和抑郁症。
