Research and Scientific Center, Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia.
Armed Forces Hospital, Southern Region, Khamis Mushayt, Saudi Arabia.
Curr Med Res Opin. 2023 Jan;39(1):27-35. doi: 10.1080/03007995.2022.2144052. Epub 2022 Nov 28.
Patients with type 2 diabetes nowadays have a wide range of new antidiabetic medications with better efficacy and safety. Physicians' attitude toward selecting antidiabetic medications to reach targeted glycemic control and better quality of life (QOL) has not been studied prospectively. The global DISCOVER study aims to comprehensively provide a real-world assessment of the treatment pattern changes for patients with type 2 diabetes, in addition to QOL assessment. The Kingdom of Saudi Arabia was one of the countries participating in the DISCOVER study program.
This study is a part of the prospective, longitudinal multinational DISCOVER study conducted in 38 countries including Saudi Arabia, a country facing an epidemic of type 2 diabetes, recruited 519 adult patients with type 2 diabetes with a mean age of 52.4 ± 11 years, where, they were followed up for three years period, where 477 patients completed the follow-up period. The clinical, biochemical, and patient lifestyle data were assessed periodically during the study period. DISCOVER study is registered with ClinicalTrials.gov identifiers: NCT02322762.
The most frequently used antidiabetic medications (ADMs) initially and during the follow-up were biguanides (metformin) and sulfonylureas (gliclazide, glibenclamide, glimepiride, glipizide, and glyclopyramide). Insulin (premix Insulin, basal insulin, and basal/bolus insulin) and dipeptidyl peptidase-4 (DPP-4) inhibitors (sitagliptin, vildagliptin, saxagliptin, and linagliptin) were the most frequent second and alternative of therapy. Other medications namely thiazolidinediones (TZds) (pioglitazone and rosiglitazone), incretins (exenatide and liraglutide), and Sodium-glucose co-transporter-2 (SGLT-2) inhibitors (canagliflozin) were used at a lesser rate. Drug availability, efficacy, and safety were the main determinants for choosing antidiabetic medications. The physical component score of the QOL had shown a significant decrease, while the mental component score has demonstrated an increase in QOL using SF36v2 Survey.
There is an increasing trend of using of newly available ADMs, mainly DPP-4 inhibitors. The major limitation of ADMs use is related to efficacy, availability, and safety. This warrant taking all the measures to overcome these limitations through adopting a multidisciplinary team approach for close monitoring of the patients and any unfavorable side effects. Additionally, global insurance coverage for all patients with type 2 diabetes could be a solution for the drug availability factor.
如今，2 型糖尿病患者有多种新的降糖药物可供选择，这些药物具有更好的疗效和安全性。然而，医生在选择降糖药物以达到目标血糖控制和提高生活质量（QOL）方面的态度尚未得到前瞻性研究。全球 DISCOVER 研究旨在全面评估 2 型糖尿病患者治疗模式的变化，同时评估 QOL。沙特阿拉伯是参与 DISCOVER 研究计划的国家之一。
本研究是前瞻性、纵向多国 DISCOVER 研究的一部分，该研究在包括沙特阿拉伯在内的 38 个国家进行，招募了 519 名平均年龄为 52.4±11 岁的 2 型糖尿病成年患者，随访 3 年，其中 477 名患者完成了随访。在研究期间，定期评估临床、生化和患者生活方式数据。DISCOVER 研究在 ClinicalTrials.gov 注册，注册号为 NCT02322762。
最初和随访期间最常使用的降糖药物（ADM）是双胍类（二甲双胍）和磺酰脲类（格列齐特、格列本脲、格列吡嗪、格列齐特和格列美脲）。胰岛素（预混胰岛素、基础胰岛素和基础/餐时胰岛素）和二肽基肽酶-4（DPP-4）抑制剂（西格列汀、维格列汀、沙格列汀和利格列汀）是最常用的二线和替代治疗药物。其他药物，即噻唑烷二酮类（TZds）（吡格列酮和罗格列酮）、肠促胰岛素（艾塞那肽和利拉鲁肽）和钠-葡萄糖协同转运蛋白-2（SGLT-2）抑制剂（卡格列净）的使用频率较低。药物的可获得性、疗效和安全性是选择降糖药物的主要决定因素。SF36v2 调查显示，生活质量的生理成分评分显著下降，而心理成分评分有所增加。
新的降糖药物（ADM）的使用呈上升趋势，主要是 DPP-4 抑制剂。ADM 使用的主要限制与疗效、可获得性和安全性有关。这需要采取一切措施，通过采用多学科团队方法密切监测患者和任何不良反应，来克服这些限制。此外，为所有 2 型糖尿病患者提供全球保险覆盖可能是解决药物可获得性问题的一个方案。
