Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan.
Kansai Electric Power Medical Research Institute, Kobe, Japan.
J Diabetes Investig. 2022 May;13(5):810-821. doi: 10.1111/jdi.13728. Epub 2022 Jan 11.
AIMS/INTRODUCTION: We investigated the utilization of healthcare resources in patients with type 2 diabetes treated with empagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor, versus dipeptidyl peptidase-4 (DPP-4) inhibitors in clinical practice in Japan, South Korea, and Taiwan.
We analyzed the Japanese Medical Data Vision database (December 2014-April 2018), the South Korean National Health Information Database, and the Taiwanese National Health Insurance claims database (both May 2016-December 2017). Patients with type 2 diabetes starting empagliflozin, 10 or 25 mg, or a DPP-4 inhibitor were matched 1:1 via propensity scores (PS). We compared inpatient care needs, emergency room (ER) visits, and outpatient visits between the treatment groups using Poisson regression and Cox proportional hazards models, pooled across countries by random-effects meta-analysis.
We identified 28,712 pairs of PS-matched patients; the mean follow-up was 5.7-6.8 months. Empagliflozin-treated patients had a 27% lower risk of all-cause hospitalization compared with DPP-4 inhibitor-treated patients (rate ratio [RR] 0.73, 95% CI 0.67-0.79), and 23% reduced risk for first hospitalization (hazard ratio 0.77, 95% CI 0.73-0.81). The risk for an ER visit was 12% lower with empagliflozin than with DPP-4 inhibitors (RR 0.88, 95% CI 0.83-0.94) while the risk for outpatient visit was 4% lower (RR 0.96, 95% CI 0.96-0.97). These findings were generally consistent across countries, regardless of baseline cardiovascular disease, and in the subgroup starting empagliflozin with the 10 mg dose.
Empagliflozin treatment was associated with lower inpatient care needs and other healthcare resource utilization than DPP-4 inhibitors in routine clinical practice in East Asia in this study.
目的/引言：我们调查了钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂恩格列净与二肽基肽酶-4（DPP-4）抑制剂在日本、韩国和中国台湾地区 2 型糖尿病患者中的医疗资源利用情况。
我们分析了日本医疗数据视野数据库（2014 年 12 月至 2018 年 4 月）、韩国国家健康信息数据库和中国台湾地区全民健康保险理赔数据库（均为 2016 年 5 月至 2017 年 12 月）。将起始接受恩格列净（10 或 25mg）或 DPP-4 抑制剂治疗的 2 型糖尿病患者按倾向评分（PS）1:1 匹配。采用泊松回归和 Cox 比例风险模型比较两组患者的住院治疗需求、急诊就诊和门诊就诊情况，并通过随机效应荟萃分析在各国间进行汇总。
我们共确定了 28712 对 PS 匹配患者；平均随访时间为 5.7-6.8 个月。与 DPP-4 抑制剂治疗患者相比，恩格列净治疗患者全因住院治疗风险降低了 27%（率比 [RR] 0.73，95%CI 0.67-0.79），首次住院风险降低了 23%（风险比 [HR] 0.77，95%CI 0.73-0.81）。与 DPP-4 抑制剂相比，恩格列净治疗患者急诊就诊风险降低了 12%（RR 0.88，95%CI 0.83-0.94），门诊就诊风险降低了 4%（RR 0.96，95%CI 0.96-0.97）。无论基线心血管疾病情况如何，这些发现均在东亚国家的常规临床实践中普遍一致，且在起始接受恩格列净 10mg 剂量的亚组中也是如此。
在本研究中，与 DPP-4 抑制剂相比，恩格列净治疗在东亚常规临床实践中与较低的住院治疗需求和其他医疗资源利用相关。
