Hopkins Rhian, Young Katherine G, Thomas Nicholas J, Jones Angus G, Hattersley Andrew T, Shields Beverley M, Dennis John M, McGovern Andrew P
Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK.
Diabetes Obes Metab. 2025 Mar;27(3):1544-1553. doi: 10.1111/dom.16163. Epub 2025 Jan 6.
To assess outcomes of oral anti-hyperglycaemic therapies in people with diabetes secondary to a pancreatic condition (type 3c), where specific treatment guidance is limited.
Using hospital-linked UK primary care records (Clinical Practice Research Datalink; 2004-2020), we identified 7084 people with a pancreatic condition (acute pancreatitis, chronic pancreatitis, pancreatic cancer and haemochromatosis) preceding diabetes diagnosis (type 3c cohort), initiating oral glucose-lowering therapy (metformin, sulphonylureas, SGLT2-inhibitors, DPP4-inhibitors or thiazolidinediones), and without concurrent insulin treatment. We stratified by pancreatic exocrine insufficiency [PEI] (n = 5917 without PEI, 1167 with PEI) and matched to 97 227 type 2 diabetes (T2D) controls. 12-month HbA1c response and weight change and 6-month treatment discontinuation were compared in type 3c versus T2D.
People with type 3c diabetes had substantial mean HbA1c reduction with oral therapies in those without PEI (12.2 [95%CI 12.0-12.4] mmol/mol) and with PEI (9.4 [8.9-10.0] mmol/mol). Compared to T2D controls, people with type 3c without PEI had similar mean HbA1c reduction (0.7 [0.4-1.0] mmol/mol difference) and odds of discontinuation (Odds ratio [OR] 1.08 [0.98-1.19]). In contrast, people with type 3c and PEI had lower mean HbA1c response (3.5 [2.9-4.1] mmol/mol lesser reduction) and greater discontinuation (OR 2.03 [1.73-2.36]) versus T2D controls. Weight change in type 3c was similar to T2D. Results were largely consistent across underlying pancreatic conditions and drug classes.
Oral anti-hyperglycaemic therapies are effective in people with type 3c diabetes and could provide an important component of glycaemic management. PEI could identify people with type 3c requiring closer monitoring of treatment response.
评估在胰腺疾病继发糖尿病（3c型）患者中口服降糖治疗的效果，此类患者的具体治疗指导有限。
利用与医院相关的英国初级医疗记录（临床实践研究数据链；2004 - 2020年），我们确定了7084例在糖尿病诊断前患有胰腺疾病（急性胰腺炎、慢性胰腺炎、胰腺癌和血色素沉着症）的患者（3c型队列），这些患者开始接受口服降糖治疗（二甲双胍、磺脲类药物、钠 - 葡萄糖协同转运蛋白2抑制剂、二肽基肽酶4抑制剂或噻唑烷二酮类药物），且未同时接受胰岛素治疗。我们根据胰腺外分泌功能不全[PEI]进行分层（n = 5917例无PEI，1167例有PEI），并与97227例2型糖尿病（T2D）对照进行匹配。比较3c型患者与T2D患者的12个月糖化血红蛋白反应、体重变化以及6个月治疗中断情况。
在无PEI的3c型糖尿病患者（12.2[95%CI 12.0 - 12.4] mmol/mol）和有PEI的患者（9.4[8.9 - 10.0] mmol/mol）中，口服治疗可使糖化血红蛋白均值显著降低。与T2D对照相比，无PEI的3c型患者糖化血红蛋白均值降低程度相似（差异为0.7[0.4 - 1.0] mmol/mol），治疗中断几率也相似（比值比[OR] 1.08[0.98 - 1.19]）。相比之下，有PEI的3c型患者与T2D对照相比，糖化血红蛋白均值反应较低（降低幅度小3.5[2.9 - 4.1] mmol/mol），治疗中断几率更高（OR 2.03[1.73 - 2.36]）。3c型患者的体重变化与T2D患者相似。在不同的潜在胰腺疾病和药物类别中，结果基本一致。
口服降糖治疗对3c型糖尿病患者有效，可为血糖管理提供重要组成部分。PEI可识别出需要密切监测治疗反应的3c型患者。
