National Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca Milan, Milan, Italy.
Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca Degli Arcimboldi, 8, Edificio, U7, 20126, Milan, Italy.
Cardiovasc Diabetol. 2023 Mar 10;22(1):53. doi: 10.1186/s12933-023-01786-8.
To evaluate the protective effect of oral antidiabetic drugs in a large cohort of elderly patients with type 2 diabetes differing for age, clinical status, and life expectancy, including patients with multiple comorbidities and short survival.
A nested case-control study was carried out by including the cohort of 188,983 patients from Lombardy (Italy), aged ≥ 65 years, who received ≥ 3 consecutive prescriptions of antidiabetic agents (mostly metformin and other older conventional agents) during 2012. Cases were the 49,201 patients who died for any cause during follow-up (up to 2018). A control was randomly selected for each case. Adherence to drug therapy was measured by considering the proportion of days of the follow-up covered by the drug prescriptions. Conditional logistic regression was used to model the risk of outcome associated with adherence to antidiabetic drugs. The analysis was stratified according to four categories of the clinical status (good, intermediate, poor, and very poor) differing for life expectancy.
There was a steep increase in comorbidities and a marked reduction of the 6-year survival from the very good to the very poor (or frail) clinical category. Progressive increase in adherence to treatment was associated with a progressive decrease in the risk of all-cause mortality in all clinical categories and at all ages (65-74, 75-84 and ≥ 85 years) except for the frail patient subgroup aged ≥ 85 years. The mortality reduction from lowest to highest adherence level showed a tendency to be lower in frail patients compared to the other categories. Similar although less consistent results were obtained for cardiovascular mortality.
In elderly diabetic patients, increased adherence to antidiabetic drugs is associated with a reduction in the risk of mortality regardless of the patients' clinical status and age, with the exception of very old patients (age ≥ 85 years) in the very poor or frail clinical category. However, in the frail patient category the benefit of treatment appears to be less than in patients in good clinical conditions.
为了评估口服降糖药物在 2 型糖尿病老年患者中的保护作用，这些患者的年龄、临床状况和预期寿命存在差异，包括患有多种合并症和预期寿命较短的患者。
通过纳入意大利伦巴第大区的 188983 名年龄≥65 岁的患者队列，开展了一项巢式病例对照研究，这些患者在 2012 年期间接受了≥3 次连续的降糖药物处方（主要是二甲双胍和其他较老的常规药物）。病例为随访期间（截至 2018 年）因任何原因死亡的 49201 名患者。为每个病例随机选择一名对照。通过考虑药物处方随访天数的比例来衡量药物治疗的依从性。采用条件逻辑回归模型来模拟与降糖药物依从性相关的结局风险。分析根据预期寿命不同的四个临床状态（良好、中等、较差和极差）进行分层。
随着临床状态从极好变为极差（或虚弱），合并症的数量急剧增加，6 年生存率显著降低。治疗依从性的逐渐增加与所有临床状态和所有年龄段（65-74、75-84 和≥85 岁）的全因死亡率风险逐渐降低相关，除了年龄≥85 岁的虚弱患者亚组外。从最低到最高依从水平的死亡率降低在虚弱患者中与其他类别相比，呈下降趋势。对于心血管死亡率，也得到了类似但不太一致的结果。
在老年糖尿病患者中，增加降糖药物的依从性与降低死亡率相关，无论患者的临床状态和年龄如何，除了临床状态极差（虚弱）的非常高龄（年龄≥85 岁）患者外。然而，在虚弱患者亚组中，治疗的获益似乎低于临床状况良好的患者。
