2型糖尿病合并COVID-19住院患者中SGLT2抑制剂治疗与糖尿病酮症酸中毒及死亡率之间的关联
Association Between SGLT2 Inhibitor Treatment and Diabetic Ketoacidosis and Mortality in People With Type 2 Diabetes Admitted to Hospital With COVID-19.
作者信息
Khunti Kamlesh, Ruan Yue, Davies Jim, Field Benjamin C T, Harris Sophie, Kosiborod Mikhail, Nagi Dinesh, Narendran Parth, Patel Dipesh, Ryder Robert E J, Várnai Kinga A, Wild Sarah H, Wilmot Emma G, Rea Rustam
机构信息
Diabetes Research Centre, University of Leicester, Leicester, U.K.
Oxford National Institute for Health Research Biomedical Research Centre, Oxford, U.K.
出版信息
Diabetes Care. 2022 Sep 8. doi: 10.2337/dc22-0357.
OBJECTIVE
To determine the association between prescription of SGLT2 inhibitors (SGLT2is) and diabetic ketoacidosis (DKA) incidence or mortality in people with type 2 diabetes (T2D) hospitalized with COVID-19.
RESEARCH DESIGN AND METHODS
This was a retrospective cohort study based on secondary analysis of data from a large nationwide audit from a network of 40 centers in the U.K. with data collection up to December 2020. The study was originally designed to describe risk factors associated with adverse outcomes among people with diabetes who were admitted to hospital with COVID-19. The primary outcome for this analysis was DKA on or during hospital admission. The secondary outcome was mortality. Crude, age-sex adjusted, and multivariable logistic regression models were used to generate odds ratios (ORs) and 95% CIs for people prescribed SGLT2i compared with those not prescribed SGLT2i.
RESULTS
The original national audit included 3,067 people with T2D who were admitted to hospital with COVID-19, of whom 230 (7.5%) were prescribed SGLT2is prior to hospital admission. The mean age of the overall cohort was 72 years, 62.3% were men, and 34.9% were prescribed insulin. Overall, 2.8% of the total population had DKA and 35.6% of people in the study died. The adjusted odds of DKA were not significantly different between those prescribed SGLT2is and those not (OR 0.56; 95% CI 0.16-1.97). The adjusted odds of mortality associated with SGLT2is were similar in the total study population (OR 1.13; 95% CI 0.78-1.63), in the subgroup prescribed insulin (OR 1.02; 95% CI 0.59-1.77), and in the subgroup that developed DKA (OR 0.21; 95% CI 0.01-8.76).
CONCLUSIONS
We demonstrate a low risk of DKA and high mortality rate in people with T2D admitted to hospital with COVID-19 and limited power, but no evidence, of increased risk of DKA or in-hospital mortality associated with prescription of SGLT2is.
目的
确定2型糖尿病（T2D）合并COVID-19住院患者中，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）的处方与糖尿病酮症酸中毒（DKA）发生率或死亡率之间的关联。
研究设计与方法
这是一项回顾性队列研究，基于对英国40个中心网络的一项大型全国性审计数据的二次分析，数据收集截至2020年12月。该研究最初旨在描述合并COVID-19入院的糖尿病患者不良结局的相关危险因素。本次分析的主要结局是入院时或住院期间发生DKA。次要结局是死亡率。使用粗率、年龄-性别校正和多变量逻辑回归模型，生成服用SGLT2i与未服用SGLT2i患者的比值比（OR）和95%置信区间（CI）。
结果
最初的全国性审计纳入了3067例合并COVID-19入院的T2D患者，其中230例（7.5%）在入院前服用SGLT2i。整个队列的平均年龄为72岁，62.3%为男性，34.9%使用胰岛素治疗。总体而言，总人群中2.8%发生DKA，研究中35.6%的患者死亡。服用SGLT2i与未服用者发生DKA的校正比值无显著差异（OR 0.56；95%CI 0.16-1.97）。在整个研究人群中，与SGLT2i相关的死亡校正比值相似（OR 1.13；95%CI 0.78-1.63），在使用胰岛素治疗的亚组中（OR 1.02；95%CI 0.59-1.77），以及在发生DKA的亚组中（OR 0.21；95%CI 0.01-8.76）。
结论
我们证明，合并COVID-19入院的T2D患者发生DKA的风险较低，死亡率较高，且证据有限，但没有证据表明服用SGLT2i会增加DKA风险或院内死亡率。
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