Shi Chenyang, Hu Shanshan, Lin Yi, Qin Yingyi, Tang Yuanjun, Fan Guorong, Tang Zhaosheng
Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Endocrine. 2025 Feb;87(2):498-509. doi: 10.1007/s12020-024-04017-6. Epub 2024 Sep 9.
To assess the real-world impact of glucose-lowering drugs (GLDs) as an adjunct to insulin in Chinese patients with type 1 diabetes (T1DM).
This dual-center, observational, retrospective study included 121 T1DM patients receiving GLDs as adjuncts and 56 participants with insulin-only drugs as comparators. Glycated hemoglobin A1c (HbA1c), daily insulin dosage, fasting blood glucose (FBG), postprandial blood glucose (PBG), nocturnal blood glucose (NBG) and the difference in trough and peak blood glucose levels on the same day (Δ TP) were assessed at baseline and at the end of the study.
In total, HbA1c decreased by 1.14% in the GLD+insulin group (p < 0.0001) and 0.36% in the insulin-only group (p = 0.0423, mean adjusted difference, -0.09% [95% CI, -0.55 to 0.37]). The total daily insulin concentration was reduced by 7.34 U per day in the GLD+insulin group vs. 5.55 U per day in the insulin-only group (mean adjusted difference, -2.32 U [95% CI, -4.97 to 0.33]). In particular, among patients with fasting C-peptide levels < 17 pmol/L, the total daily insulin concentration was significantly reduced by 9.22 U vs. 5.09 U per day (mean adjusted difference, -3.84 [95% CI, -6.85-0.84]; p = 0.0129). There were no notable differences in the other glycemic indices between the two groups. A gradual downward trend in changes in glycemic outcomes was observed among patients treated with various combinations of metformin, acarbose, and dipeptidyl peptidase 4 inhibitor (DPP-4i). Similar reductions in the daily insulin dose were also detected in most of the GLD+insulin group in addition to the DPP-4i-only group. No severe hypoglycemia was induced by additional GLDs.
The use of additional GLDs tends to improve glycemic outcomes and reduce insulin requirements in patients with T1DM. These results indicate that the use of GLDs as an adjunctive therapy may have been an effective treatment strategy among adults with T1DM in China.
评估降糖药物（GLDs）作为1型糖尿病（T1DM）中国患者胰岛素辅助治疗的实际效果。
这项双中心、观察性、回顾性研究纳入了121例接受GLDs作为辅助治疗的T1DM患者和56例仅使用胰岛素药物的参与者作为对照。在基线和研究结束时评估糖化血红蛋白A1c（HbA1c）、每日胰岛素剂量、空腹血糖（FBG）、餐后血糖（PBG）、夜间血糖（NBG）以及同一天血糖谷值与峰值水平的差异（ΔTP）。
总体而言，GLD+胰岛素组的HbA1c下降了1.14%（p<0.0001），仅胰岛素组下降了0.36%（p=0.0423，平均校正差异为-0.09%[95%CI，-0.55至0.37]）。GLD+胰岛素组的每日胰岛素总量每天减少7.34 U，而仅胰岛素组每天减少5.55 U（平均校正差异为-2.32 U[95%CI，-4.97至0.33]）。特别是，在空腹C肽水平<17 pmol/L的患者中，每日胰岛素总量显著减少，分别为9.22 U和5.09 U（平均校正差异为-3.84[95%CI，-6.85至-0.84]；p=0.0129）。两组之间的其他血糖指标没有显著差异。在接受二甲双胍、阿卡波糖和二肽基肽酶-4抑制剂（DPP-4i）不同组合治疗的患者中，观察到血糖结果变化呈逐渐下降趋势。除了仅使用DPP-4i的组外，大多数GLD+胰岛素组的每日胰岛素剂量也有类似程度的降低。额外使用GLDs未诱发严重低血糖。
额外使用GLDs倾向于改善T1DM患者的血糖结果并降低胰岛素需求。这些结果表明，在中国，使用GLDs作为辅助治疗可能是T1DM成年患者的一种有效治疗策略。
