Saw Swee Hock School of Public Health, National University of Singapore, MD1 - Tahir Foundation Building, 12 Science Drive 2, #11, Singapore, 117549, Singapore.
Institute of Data Science, National University of Singapore, Singapore, Singapore.
Sci Rep. 2023 Nov 28;13(1):20891. doi: 10.1038/s41598-023-47896-x.
Evidence on the influence of patient characteristics on HbA treatment response for add-on medications in patients with type 2 diabetes (T2D) is unclear. This study aims to investigate the predictors of HbA treatment response for three add-on medications (sulfonylureas (SU), dipeptidyl peptidase-4 (DPP-4) and sodium-glucose cotransporter-2 (SGLT-2) inhibitor) in metformin monotherapy treated patients with T2D. This retrospective cohort study was conducted using the electronic health record data from six primary care clinics in Singapore. A total of 9748 adult patients with T2D on metformin monotherapy receiving SU, DPP-4 or SGLT-2 add-on were 1:1 propensity score matched to patients receiving other add-on medications. Patient demographics, laboratory results, diabetes related complications, comedications, and treatment response at two endpoints (HbA reduction ≥ 1% at 6th month, HbA goal attainment < 7% at 12th month) were examined. Multiple logistic regression analyses were used to identify patient characteristics associated with the treatment responses. After matching, there were 1073, 517, and 290 paired cohorts of SU, DPP-4 and SGLT-2 respectively. Besides baseline HbA, patients with longer hypertension disease duration and higher cholesterol HDL were associated with better treatment response to SU medication add-on. Lower estimated glomerular filtration rate (eGFR), and angiotensin-II receptor medications were associated with better treatment response to DPP-4 add-on. Lower cholesterol HDL, higher creatinine serum, absence of renal complications and beta-blockers medications were associated with better treatment response to SGLT-2 add-on. The cholesterol HDL, creatinine serum, eGFR, hypertension disease duration, angiotensin-II receptors and beta-blockers class of medications can influence the HbA treatment response for SU, DPP-4 and SGLT-2 add-on medications. Knowing the patients' characteristics that influence treatment response can assist in guiding clinical decisions when selecting the appropriate add-on medication, ultimately helping to prevent the development of diabetes-related complications.
关于患者特征对 2 型糖尿病（T2D）患者添加药物治疗血红蛋白 A（HbA）反应的影响的证据尚不清楚。本研究旨在探讨在接受二甲双胍单药治疗的 T2D 患者中，三种添加药物（磺酰脲类（SU）、二肽基肽酶-4（DPP-4）和钠-葡萄糖共转运蛋白-2（SGLT-2）抑制剂）治疗 HbA 反应的预测因素。这项回顾性队列研究使用了来自新加坡六家初级保健诊所的电子健康记录数据。共有 9748 名接受二甲双胍单药治疗的 T2D 成年患者接受 SU、DPP-4 或 SGLT-2 添加物治疗，与接受其他添加物治疗的患者按 1:1 比例进行倾向评分匹配。检查了患者的人口统计学特征、实验室结果、糖尿病相关并发症、合并用药以及在两个终点（第 6 个月 HbA 降低≥1%，第 12 个月 HbA 达标<7%）的治疗反应。采用多因素逻辑回归分析确定与治疗反应相关的患者特征。匹配后，SU、DPP-4 和 SGLT-2 分别有 1073、517 和 290 对配对队列。除了基线 HbA 外，高血压病史较长和胆固醇高密度脂蛋白（HDL）较高的患者，SU 药物添加治疗的反应较好。估计肾小球滤过率（eGFR）较低和血管紧张素-II 受体药物与 DPP-4 添加物治疗反应较好相关。胆固醇 HDL 较低、肌酐血清较高、无肾脏并发症和β受体阻滞剂药物与 SGLT-2 添加物治疗反应较好相关。胆固醇 HDL、肌酐血清、eGFR、高血压病史、血管紧张素-II 受体和β受体阻滞剂类药物可影响 SU、DPP-4 和 SGLT-2 添加药物的 HbA 治疗反应。了解影响治疗反应的患者特征可以帮助指导选择合适的添加药物的临床决策，最终有助于预防糖尿病相关并发症的发生。
