Pilla Scott J, Wang Isabelle J, Tang Olive, Schoenborn Nancy L, Boyd Cynthia M, Bancks Michael P, Mathioudakis Nestoras N, Maruthur Nisa M
Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD.
Clin Diabetes. 2024 Sep 5;43(1):33-42. doi: 10.2337/cd24-0043. eCollection 2025 Winter.
This study was a national survey of U.S. physicians in general medicine, geriatrics, or endocrinology who were asked what medication change they would make for adults with type 2 diabetes taking sulfonylureas or insulin with an A1C below their individualized goal. Responding physicians switched the hypoglycemia-causing medication a median of 4 times (interquartile range 1-9) among 27 opportunities and selected dipeptidyl peptidase 4 inhibitors most often when switching. Sodium-glucose cotransporter 2 inhibitors were selected less frequently, including when indicated for cardiovascular and renal comorbidities, but significantly more often among physicians caring for a greater proportion of patients with private health insurance. Overcoming barriers to switching hypoglycemia-causing medications may help to reduce rates of hypoglycemia while targeting cardiovascular and renal comorbidities.
这项研究是一项针对美国普通内科、老年医学或内分泌学领域医生的全国性调查，这些医生被问及对于糖化血红蛋白（A1C）低于个体化目标值的服用磺脲类药物或胰岛素的2型糖尿病成人患者，他们会做出何种药物调整。做出回应的医生在27次机会中，将导致低血糖的药物更换了中位数为4次（四分位间距为1 - 9），更换时最常选择二肽基肽酶4抑制剂。钠-葡萄糖协同转运蛋白2抑制剂的选择频率较低，包括在有心血管和肾脏合并症指征时，但在照顾有私人医疗保险的患者比例更高的医生中选择频率显著更高。克服更换导致低血糖药物的障碍可能有助于降低低血糖发生率，同时针对心血管和肾脏合并症。
