Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Center for Quantitative Metabolic Research, Cleveland Clinic, Cleveland, Ohio, USA.
Diabetes Obes Metab. 2024 Nov;26(11):5347-5357. doi: 10.1111/dom.15896. Epub 2024 Aug 27.
To investigate the independent contributions of glycated haemoglobin (HbA1c) reduction and weight loss to clinical outcomes in patients with type 2 diabetes (T2D) treated with antidiabetic drugs, including glucagon-like peptide-1 receptor agonists (GLP-1RAs).
This observational, retrospective cohort study used deidentified electronic health record-derived data from patients evaluated at the Cleveland Clinic (1 January 2000-31 December 2020). Cohort A included 8876 patients with newly diagnosed T2D treated with any of six antidiabetic drug classes. Cohort B included 4161 patients with T2D initiating GLP-1RA treatment. The effects of body mass index (BMI) and HbA1c reduction, variability, and durability on clinical outcomes were investigated.
In Cohort A, each 1% BMI reduction was associated with 3%, 1%, and 4% reduced risk of heart failure (p = 0.017), hypertension (p = 0.006), and insulin initiation (p = 0.001), respectively. Each 1% (11 mmol/mol) HbA1c reduction was associated with 4% and 29% reduced risk of hypertension (p = 0.041) and insulin initiation (p = 0.001), respectively. In Cohort B, each 1% BMI reduction was associated with 4% and 3% reduced risk of cardiovascular disease (p = 0.008) and insulin initiation (p = 0.002), respectively. Each 1% (11 mmol/mol) HbA1c reduction was associated with 4% and 16% reduced risk of chronic kidney disease (p = 0.014) and insulin initiation (p = 1 × 10), respectively. Lower BMI variability and greater BMI durability were associated with decreased risk of clinical outcomes in both cohorts.
Antidiabetic medication-associated, and specifically GLP-1RA-associated, weight loss and HbA1c reductions independently reduce real-world clinical outcome risk.
研究在接受包括胰高血糖素样肽-1 受体激动剂（GLP-1RA）在内的降糖药物治疗的 2 型糖尿病（T2D）患者中，糖化血红蛋白（HbA1c）降低和体重减轻对临床结局的独立贡献。
这是一项使用克利夫兰诊所（2000 年 1 月 1 日至 2020 年 12 月 31 日）的电子健康记录中提取的匿名数据进行的观察性回顾性队列研究。队列 A 包括 8876 名接受六种降糖药物治疗的新诊断 T2D 患者。队列 B 包括 4161 名开始 GLP-1RA 治疗的 T2D 患者。研究了体重指数（BMI）和 HbA1c 降低、变异性和持久性对临床结局的影响。
在队列 A 中，BMI 每降低 1%，心力衰竭（p=0.017）、高血压（p=0.006）和胰岛素起始（p=0.001）的风险分别降低 3%、1%和 4%。HbA1c 每降低 1%（11mmol/mol），高血压（p=0.041）和胰岛素起始（p=0.001）的风险分别降低 4%和 29%。在队列 B 中，BMI 每降低 1%，心血管疾病（p=0.008）和胰岛素起始（p=0.002）的风险分别降低 4%和 3%。HbA1c 每降低 1%（11mmol/mol），慢性肾脏病（p=0.014）和胰岛素起始（p=1×10）的风险分别降低 4%和 16%。在两个队列中，BMI 变异性降低和 BMI 持久性增加与临床结局风险降低相关。
降糖药物相关，特别是 GLP-1RA 相关的体重减轻和 HbA1c 降低可独立降低真实世界临床结局风险。
