二甲双胍和磺脲类药物单独或联合治疗的持续时间对新诊断2型糖尿病患者糖尿病视网膜病变的影响：一项汇总队列分析
Impact of duration of treatments with metformin and sulfonylureas, individually or in combination, on diabetic retinopathy among newly diagnosed type 2 diabetic patients: a pooled cohort's analysis.
作者信息
Bahardoust Mansour, Mehrabi Yadollah, Hadaegh Farzad, Khalili Davood, Delpisheh Ali
机构信息
Department of Epidemiology, School of Public Health & Safety, Shahid Beheshti University of Medical Sciences, Velenjak, 7th Floor, Bldg No.2 SBUMS, Arabi Ave, Tehran, Tehran Province, Iran.
Prevention of Metabolic Disorders Research Center, Division of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Velenjak, Yaman St, Aarabi St, No.24, Tehran, Iran.
出版信息
Int J Retina Vitreous. 2025 Jan 31;11(1):9. doi: 10.1186/s40942-025-00637-w.
BACKGROUND
This study aimed to evaluate the effect of metformin and sulfonylurea (SUs) medication time on Diabetic retinopathy (DR) among newly diagnosed patients with type 2 diabetes (T2DM) using a pooled analysis. This study aimed to evaluate the effect of metformin and SUs' medication time on DR among newly diagnosed T2DM using a pooled analysis.
METHODS
The data of 4,068 newly diagnosed DM individuals(mean age, 60.2 ± 0.85 years) from three prospective cohorts of Tehran Sugar and Lipid Study (TLGS), Multi-Ethnic Study of Atherosclerosis (MESA), and Atherosclerosis Risk in Communities (ARIC) with a mean age of 59.6 ± 08 years were pooled. The cumulative exposure to metformin, SUs, aspirin, statin, and anti-hypertensive medication was also determined using the same approach. The Cox proportional hazards (CPH) model was used to calculate the hazard ratio (HR) (95% CI) for the outcomes while adjusting for confounding factors such as fasting Blood Sugar (FBS), age, statin, aspirin, and anti-hypertensive medications.
RESULTS
During follow-up, DR occurred in 519 DM. Metformin alone, SUs alone, and the combination of both reduced the hazard of DR by 10%, 7%, and 11% for each year of use, respectively (p < 0.05). The protective effect of metformin and SUs, individually or in combination, on DR started approximately five years after the initial treatment and continued until approximately 15 years after the initial treatment and then reached a plato.
CONCLUSION
Long-term treatment with metformin and SUs, individually and in combination, was associated with a reduced risk of DR in people with newly diagnosed diabetes for up to a decade compared with no treatment. These findings highlight the protective role of metformin and sulfonylureas as inexpensive and readily available drugs to prevent DR in people with newly diagnosed diabetes.
背景
本研究旨在通过汇总分析评估二甲双胍和磺脲类药物（SUs）的用药时间对新诊断的2型糖尿病（T2DM）患者糖尿病视网膜病变（DR）的影响。本研究旨在通过汇总分析评估二甲双胍和SUs的用药时间对新诊断的T2DM患者DR的影响。
方法
汇总了来自德黑兰糖脂研究（TLGS）、多民族动脉粥样硬化研究（MESA）和社区动脉粥样硬化风险研究（ARIC）这三个前瞻性队列的4068例新诊断糖尿病个体（平均年龄60.2±0.85岁）的数据，平均年龄为59.6±0.8岁。还采用相同方法确定了二甲双胍、SUs、阿司匹林、他汀类药物和抗高血压药物的累积暴露量。使用Cox比例风险（CPH）模型计算结局的风险比（HR）（95%CI），同时调整空腹血糖（FBS）、年龄、他汀类药物、阿司匹林和抗高血压药物等混杂因素。
结果
随访期间，519例糖尿病患者发生了DR。单独使用二甲双胍、单独使用SUs以及两者联合使用，每年使用分别使DR风险降低10%、7%和11%（p<0.05）。二甲双胍和SUs单独或联合使用对DR的保护作用在初始治疗后约五年开始，持续到初始治疗后约15年，然后达到平稳状态。
结论
与未治疗相比，新诊断糖尿病患者单独或联合使用二甲双胍和SUs进行长期治疗，长达十年可降低DR风险。这些发现凸显了二甲双胍和磺脲类药物作为廉价且易于获得的药物在预防新诊断糖尿病患者DR方面的保护作用。
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