Shorr R I, Ray W A, Daugherty J R, Griffin M R
Department of Preventive Medicine, Vanderbilt University, School of Medicine, Nashville, Tennessee, USA.
J Am Geriatr Soc. 1996 Jul;44(7):751-5. doi: 10.1111/j.1532-5415.1996.tb03729.x.
To compare the risk of serious hypoglycemia associated with the use of individual sulfonylureas in older people.
A retrospective cohort study.
The Tennessee Medicaid Program.
A total of 13,963 Medicaid enrollees, aged 65 years or older, who were prescribed one of six sulfonylureas from 1985 to 1989.
Hospitalization, emergency room admission, or death associated with neuroglycopenic or autonomic symptoms, myocardial infarction, stroke, or injury, with a concomitant blood glucose determination of less than 2.8 mmol/L (50 mg/dL).
We identified 255 persons with a first episode of serious hypoglycemia during 20,715 person-years of sulfonylurea use. The crude rate (per 1000 person-years) of serious hypoglycemia was highest in glyburide users, 16.6 (95% confidence interval [CI], 13.2 to 19.9 and lowest among users of tolbutamide, 3.5 (95% CI, 1.2 to 5.9). Users of tolbutamide, tolazamide, and glipizide had lower risks of serious hypoglycemia than users of chlorpropamide, whereas the risk of serious hypoglycemia among glyburide users did not differ from that of chlorpropamide users. Among second generation sulfonylureas, the adjusted relative risk of severe hypoglycemia among glyburide users, compared with glipizide users, was 1.9 (95% CI, 1.2 to 2.9). An increased risk of serious hypoglycemia associated with use of glyburide compared with glipizide occurred in all strata, including those defined by gender, race, nursing home residence, dose, and duration of use.
Significant differences in risk of serious hypoglycemia were observed among users of individual agents. This may be explained by duration, timing, or potency of hypoglycemic action. These data confirm previous findings that chlorpropamide use is associated with high risk of hypoglycemia and indicate that among second generation sulfonylureas, glipizide is less associated with hypoglycemia than is glyburide. More information comparing the effectiveness of glycemic control among individual sulfonylureas is needed to assist prescribers in selecting a specific agent for use in clinical practice.
比较老年人使用不同磺脲类药物时发生严重低血糖的风险。
一项回顾性队列研究。
田纳西医疗补助计划。
共有13963名年龄在65岁及以上的医疗补助计划参保者，他们在1985年至1989年期间被开具了六种磺脲类药物中的一种。
因神经低血糖症或自主神经症状、心肌梗死、中风或损伤而住院、急诊入院或死亡，同时血糖测定低于2.8 mmol/L（50 mg/dL）。
在20715人年的磺脲类药物使用期间，我们确定了255例首次发生严重低血糖的患者。格列本脲使用者严重低血糖的粗发病率（每1000人年）最高，为16.6（95%置信区间[CI]，13.2至19.9），而甲苯磺丁脲使用者最低，为3.5（95%CI，1.2至5.9）。甲苯磺丁脲、妥拉磺脲和格列吡嗪使用者发生严重低血糖的风险低于氯磺丙脲使用者，而格列本脲使用者发生严重低血糖的风险与氯磺丙脲使用者无差异。在第二代磺脲类药物中，与格列吡嗪使用者相比，格列本脲使用者发生严重低血糖的校正相对风险为1.9（95%CI，1.2至2.9）。在所有分层中，包括按性别、种族、养老院居住情况、剂量和使用时长定义的分层中，与格列吡嗪相比，使用格列本脲会增加严重低血糖的风险。
不同药物使用者发生严重低血糖的风险存在显著差异。这可能由低血糖作用的持续时间、发生时间或强度来解释。这些数据证实了先前的研究结果，即使用氯磺丙脲会增加低血糖风险，并表明在第二代磺脲类药物中，与格列本脲相比，格列吡嗪与低血糖症的关联较小。需要更多关于比较不同磺脲类药物血糖控制效果的信息，以帮助开处方者在临床实践中选择特定药物。
