JCEM:吡格列酮预防糖尿病,可以停药吗(ACT NOW研究)?

2016-03-28 Seven L MedSci原创

ACT NOW研究分析结果显示,葡萄糖耐量降低(IGT)的成年人,一旦停止服用吡格列酮,其预防2型糖尿病的保护性作用会逐渐减少,最终与对照组发展为2型糖尿病的风险相似;不过吡格列酮组与对照组相比,糖尿病的累积发病率更低,正常葡萄糖耐量的人群比例更大。该项随机、双盲、安慰剂对照试验,纳入了290名IGT患者,研究人员将参与者随机分为吡格列酮组(n=152,男性有74名,平均年龄54岁)和安慰剂对照组


ACT NOW研究分析结果显示,葡萄糖耐量降低(IGT)的成年人,一旦停止服用吡格列酮,其预防2型糖尿病的保护性作用会逐渐减少,最终与对照组发展为2型糖尿病的风险相似;不过吡格列酮组与对照组相比,糖尿病的累积发病率更低,正常葡萄糖耐量的人群比例更大。

该项随机、双盲、安慰剂对照试验,纳入了290名IGT患者,研究人员将参与者随机分为吡格列酮组(n=152,男性有74名,平均年龄54岁)和安慰剂对照组(n=138,男性有59名,平均年龄52岁),停药后平均随访11.4个月,监测参与者糖尿病和IGT发生率。

研究数据显示,随访期间,两组参与者中有17名发展为糖尿病,不过吡格列酮组与对照组相比,糖尿病的累积发病率更低(10.7% vs 22.3%; HR = 0.436; 95% CI, 0.285-0.668);正常葡萄糖耐量的人群比例更大(23% vs 13.8%; P = .04);累积正常葡萄糖耐量发生率更高(P < .05)。

进展为2型糖尿病的IGT参与者,与仍是IGT或正常葡萄糖耐量的人群相比,其胰岛素分泌/胰岛素敏感性指数更低。两组发展为糖尿病的IGT患者的β细胞功能的下降(IS/IR指数)相似。

研究结果表明,IGT患者服用吡格列酮可降低72%的发展为糖尿病的风险。不过停药后吡格列酮对于胰岛素敏感性和β细胞功能的有益作用开始减弱,停药1年,IGT个体发展为糖尿病的风险与安慰剂对照组的IGT个体相似。

低剂量吡格列酮不仅可以预防糖尿病,有研究称它还可以降低心肌梗死和非致命性卒中的风险,并且该药物的副作用十分少,绝大多数2型糖尿病患者都能负担的起的。

原始出处:

Tripathy D, et al.Diabetes Incidence and Glucose Tolerance after Termination of Pioglitazone Therapy: Results from ACT NOW . J Clin Endocrinol Metab. 2016;doi:10.1210/jc.2015-4202.

Pioglitazone benefits decrease after discontinuing therapy.Healio.March 22, 2016

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    2016-05-07 achengzhao
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    2017-03-07 smallant2015
  4. [GetPortalCommentsPageByObjectIdResponse(id=1820194, encodeId=ce6018201946d, content=<a href='/topic/show?id=854a100358e6' target=_blank style='color:#2F92EE;'>#预防糖尿病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100358, encryptionId=854a100358e6, topicName=预防糖尿病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=56ea361, createdName=changhe713, createdTime=Tue Jun 14 06:25:00 CST 2016, time=2016-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2062915, encodeId=6cb02062915a4, content=<a href='/topic/show?id=14fb10264d7' target=_blank style='color:#2F92EE;'>#JCE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10264, encryptionId=14fb10264d7, topicName=JCE)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e656479, createdName=achengzhao, createdTime=Sat May 07 04:25:00 CST 2016, time=2016-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1777533, encodeId=89e11e7753360, content=<a href='/topic/show?id=eb9610265ed' target=_blank style='color:#2F92EE;'>#JCEM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10265, encryptionId=eb9610265ed, topicName=JCEM)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2a4439169927, createdName=smallant2015, createdTime=Tue Mar 07 08:25:00 CST 2017, time=2017-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=75509, encodeId=8309e5509aa, content=学习了。学习了。学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6c891611001, createdName=medscc, createdTime=Tue Apr 05 11:54:00 CST 2016, time=2016-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=75510, encodeId=c730e551011, content=学习了。学习了。学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6c891611001, createdName=medscc, createdTime=Tue Apr 05 11:54:00 CST 2016, time=2016-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=75511, encodeId=0ec1e551170, content=学习了。学习了。学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6c891611001, createdName=medscc, createdTime=Tue Apr 05 11:54:00 CST 2016, time=2016-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447991, encodeId=f983144e991f6, content=<a href='/topic/show?id=dec73918624' target=_blank style='color:#2F92EE;'>#吡格列酮#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39186, encryptionId=dec73918624, topicName=吡格列酮)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=28075374720, createdName=bioon5, createdTime=Tue Mar 29 15:25:00 CST 2016, time=2016-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1460784, encodeId=b43b1460e84af, content=<a href='/topic/show?id=b8012e675d7' target=_blank style='color:#2F92EE;'>#停药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27675, encryptionId=b8012e675d7, topicName=停药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3c6d6379100, createdName=yinhl1980, createdTime=Tue Mar 29 15:25:00 CST 2016, time=2016-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=74412, encodeId=df1ae44120f, content=的确这样, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Tue Mar 29 06:57:00 CST 2016, time=2016-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=74413, encodeId=6749e4413ee, content=值得研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Tue Mar 29 06:57:00 CST 2016, time=2016-03-29, status=1, ipAttribution=)]
    2016-04-05 medscc

    学习了。学习了。学习了。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1820194, encodeId=ce6018201946d, content=<a href='/topic/show?id=854a100358e6' target=_blank style='color:#2F92EE;'>#预防糖尿病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100358, encryptionId=854a100358e6, topicName=预防糖尿病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=56ea361, createdName=changhe713, createdTime=Tue Jun 14 06:25:00 CST 2016, time=2016-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2062915, encodeId=6cb02062915a4, content=<a href='/topic/show?id=14fb10264d7' target=_blank style='color:#2F92EE;'>#JCE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10264, encryptionId=14fb10264d7, topicName=JCE)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e656479, createdName=achengzhao, createdTime=Sat May 07 04:25:00 CST 2016, time=2016-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1777533, encodeId=89e11e7753360, content=<a href='/topic/show?id=eb9610265ed' target=_blank style='color:#2F92EE;'>#JCEM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10265, encryptionId=eb9610265ed, topicName=JCEM)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2a4439169927, createdName=smallant2015, createdTime=Tue Mar 07 08:25:00 CST 2017, time=2017-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=75509, encodeId=8309e5509aa, content=学习了。学习了。学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6c891611001, createdName=medscc, createdTime=Tue Apr 05 11:54:00 CST 2016, time=2016-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=75510, encodeId=c730e551011, content=学习了。学习了。学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6c891611001, createdName=medscc, createdTime=Tue Apr 05 11:54:00 CST 2016, time=2016-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=75511, encodeId=0ec1e551170, content=学习了。学习了。学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6c891611001, createdName=medscc, createdTime=Tue Apr 05 11:54:00 CST 2016, time=2016-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447991, encodeId=f983144e991f6, content=<a href='/topic/show?id=dec73918624' target=_blank style='color:#2F92EE;'>#吡格列酮#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39186, encryptionId=dec73918624, topicName=吡格列酮)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=28075374720, createdName=bioon5, createdTime=Tue Mar 29 15:25:00 CST 2016, time=2016-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1460784, encodeId=b43b1460e84af, content=<a href='/topic/show?id=b8012e675d7' target=_blank style='color:#2F92EE;'>#停药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27675, encryptionId=b8012e675d7, topicName=停药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3c6d6379100, createdName=yinhl1980, createdTime=Tue Mar 29 15:25:00 CST 2016, time=2016-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=74412, encodeId=df1ae44120f, content=的确这样, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Tue Mar 29 06:57:00 CST 2016, time=2016-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=74413, encodeId=6749e4413ee, content=值得研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Tue Mar 29 06:57:00 CST 2016, time=2016-03-29, status=1, ipAttribution=)]
    2016-04-05 medscc

    学习了。学习了。学习了。

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1820194, encodeId=ce6018201946d, content=<a href='/topic/show?id=854a100358e6' target=_blank style='color:#2F92EE;'>#预防糖尿病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100358, encryptionId=854a100358e6, topicName=预防糖尿病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=56ea361, createdName=changhe713, createdTime=Tue Jun 14 06:25:00 CST 2016, time=2016-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2062915, encodeId=6cb02062915a4, content=<a href='/topic/show?id=14fb10264d7' target=_blank style='color:#2F92EE;'>#JCE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10264, encryptionId=14fb10264d7, topicName=JCE)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e656479, createdName=achengzhao, createdTime=Sat May 07 04:25:00 CST 2016, time=2016-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1777533, encodeId=89e11e7753360, content=<a href='/topic/show?id=eb9610265ed' target=_blank style='color:#2F92EE;'>#JCEM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10265, encryptionId=eb9610265ed, topicName=JCEM)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2a4439169927, createdName=smallant2015, createdTime=Tue Mar 07 08:25:00 CST 2017, time=2017-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=75509, encodeId=8309e5509aa, content=学习了。学习了。学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6c891611001, createdName=medscc, createdTime=Tue Apr 05 11:54:00 CST 2016, time=2016-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=75510, encodeId=c730e551011, content=学习了。学习了。学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6c891611001, createdName=medscc, createdTime=Tue Apr 05 11:54:00 CST 2016, time=2016-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=75511, encodeId=0ec1e551170, content=学习了。学习了。学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6c891611001, createdName=medscc, createdTime=Tue Apr 05 11:54:00 CST 2016, time=2016-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447991, encodeId=f983144e991f6, content=<a href='/topic/show?id=dec73918624' target=_blank style='color:#2F92EE;'>#吡格列酮#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39186, encryptionId=dec73918624, topicName=吡格列酮)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=28075374720, createdName=bioon5, createdTime=Tue Mar 29 15:25:00 CST 2016, time=2016-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1460784, encodeId=b43b1460e84af, content=<a href='/topic/show?id=b8012e675d7' target=_blank style='color:#2F92EE;'>#停药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27675, encryptionId=b8012e675d7, topicName=停药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3c6d6379100, createdName=yinhl1980, createdTime=Tue Mar 29 15:25:00 CST 2016, time=2016-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=74412, encodeId=df1ae44120f, content=的确这样, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Tue Mar 29 06:57:00 CST 2016, time=2016-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=74413, encodeId=6749e4413ee, content=值得研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Tue Mar 29 06:57:00 CST 2016, time=2016-03-29, status=1, ipAttribution=)]
    2016-04-05 medscc

    学习了。学习了。学习了

    0

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    2016-03-29 yinhl1980
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    2016-03-29 milkshark

    的确这样

    0

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    2016-03-29 milkshark

    值得研究

    0

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美国一项研究表明,在近期发生缺血性卒中或短暂性脑缺血发作(TIA)、有胰岛素抵抗的非糖尿病患者中,吡格列酮可降低卒中和心梗风险,同时亦可降低糖尿病罹患风险。论文2月17日在线发表于《新英格兰医学杂志》(N Engl J Med)。此项多中心双盲试验共纳入3876例近期发生缺血性卒中或TIA的患者,随机给予吡格列酮(目标剂量45mg/d)或安慰剂治疗。纳入条件为:患者未患有糖尿病,但基于稳态模型胰岛

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