Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada.
Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada.
Diabetes Obes Metab. 2023 Jun;25(6):1523-1533. doi: 10.1111/dom.15000. Epub 2023 Feb 16.
To determine whether the use of sulphonylurea monotherapy, compared with metformin monotherapy, is associated with an increased risk of ventricular arrhythmia (VA) among patients initiating pharmacotherapy for type 2 diabetes.
We conducted a population-based cohort study using electronic health data extracted from the UK's Clinical Practice Research Datalink Aurum. Using the active comparator, new-user cohort design, we compared rates of VA among patients aged 18 years or older using sulphonylurea monotherapy with those using metformin monotherapy as their initial pharmacological treatment for type 2 diabetes from April 1998 to December 2019. We used a Cox proportional hazards model with inverse probability of treatment weighting by propensity score to estimate the adjusted hazard ratio (aHR) and a corresponding bootstrap 95% confidence interval (CI) for VA with sulphonylurea monotherapy versus metformin monotherapy.
The cohort included 92 638 new users of sulphonylurea and 506 882 new users of metformin. A total of 279 VA events occurred among sulphonylurea users (rate per 10 000 person-years: 25.5, 95% CI: 22.7 to 28.7) and 1537 VA events occurred among metformin users (rate per 10 000 person-years: 18.5, 95% CI: 17.6 to 19.5). Compared with metformin, sulphonylureas were associated with an increased risk of VA (aHR: 1.42, 95% CI: 1.18 to 1.69).
Sulphonylureas are associated with an increased risk of VA when used as first-line therapy for type 2 diabetes relative to metformin use. This increased risk should be considered when prescribing sulphonylureas as an initial treatment for type 2 diabetes.
确定与二甲双胍单药治疗相比，磺酰脲类药物单药治疗是否会增加 2 型糖尿病患者起始药物治疗时发生室性心律失常（VA）的风险。
我们使用从英国临床实践研究数据链接 Aurum 中提取的电子健康数据进行了一项基于人群的队列研究。使用活性对照、新用户队列设计，我们比较了 1998 年 4 月至 2019 年 12 月期间，92638 例使用磺酰脲类药物单药治疗和 506882 例使用二甲双胍单药治疗作为 2 型糖尿病初始药物治疗的患者中 VA 的发生率。我们使用逆概率治疗加权的 Cox 比例风险模型和倾向评分估计磺酰脲类药物单药治疗与二甲双胍单药治疗相比 VA 的调整后危险比（aHR）和相应的 bootstrap95%置信区间（CI）。
该队列包括 92638 例新使用磺酰脲类药物的患者和 506882 例新使用二甲双胍的患者。磺酰脲类药物使用者中共有 279 例 VA 事件（每 10000 人年发生率：25.5，95%CI：22.7 至 28.7），二甲双胍使用者中共有 1537 例 VA 事件（每 10000 人年发生率：18.5，95%CI：17.6 至 19.5）。与二甲双胍相比，磺酰脲类药物与 VA 风险增加相关（aHR：1.42，95%CI：1.18 至 1.69）。
与二甲双胍相比，磺酰脲类药物作为 2 型糖尿病的一线治疗药物与 VA 风险增加相关。在开磺酰脲类药物作为 2 型糖尿病的初始治疗时，应考虑到这种风险增加。
