Diabetes Care:服用二甲双胍的2型糖尿病贫血风险

2020-08-17 MedSci原创 MedSci原创

服用二甲双胍与2型糖尿病患者发生贫血的早期风险有关,这一发现在两个RCT中是一致的,并且在一项真实世界的研究中得到了证实。

近日,糖尿病领域权威杂志Diabetes Care上发表了一篇研究文章,该研究通过分析随机对照试验(RCT)和真实世界人群数据,旨在评估二甲双胍与2型糖尿病贫血风险之间的关联。

贫血定义为血红蛋白量<11 g/dL。在糖尿病结局进展试验(ADOPT;n=3967)和UK前瞻性糖尿病研究(UKPDS;n=1473)RCT中,研究人员使用logistic回归对贫血风险和血液学参数变化的非线性混合模型进行建模。在糖尿病审计和研究的观察性遗传分析的苏格兰Tayside(GoDARTS)人群中(n=3485),研究人员使用离散时间失效分析来模拟累积的二甲双胍暴露对贫血风险的影响。

在ADOPT中,与磺脲类药物相比,服用二甲双胍发生贫血的比值比(OR)(95%CI)为1.93(1.10,3.38),噻唑烷二酮为4.18(2.50,7.00)。在UKPDS中,与饮食治疗相比,服用二甲双胍的OR(95%CI)为3.40(1.98,5.83),服用磺脲类药物对应的OR为0.96(0.57,1.62),注射胰岛素对应的OR为1.08(0.62,1.87)。在ADOPT中,服用二甲双胍6个月后血红蛋白和血细胞比容下降,而服用3年后没有进一步下降。在UKPDS中,与其他治疗相比,服用二甲双胍组受试者血红蛋白下降了3年。在第6年和第9年,所有治疗组的血红蛋白都有所降低,在二甲双胍组中没有观察更大的差异。在GoDARTS中,每使用1g/天的二甲双胍会使贫血风险每年增加2%。

由此可见,服用二甲双胍与2型糖尿病患者发生贫血的早期风险有关,这一发现在两个RCT中是一致的,并且在一项真实世界的研究中得到了证实。血红蛋白早期下降的机制尚未明确,但鉴于时间的推移,不可能仅由于维生素B12缺乏所致。

原始出处:

Louise A. Donnelly,et al.Risk of Anemia With Metformin Use in Type 2 Diabetes: A MASTERMIND Study.Diabetes Care.2020.https://doi.org/10.2337/dc20-1104

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content=阅读, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3282551952, createdName=12543f43m99暂无昵称, createdTime=Mon Aug 17 11:10:35 CST 2020, time=2020-08-17, status=1, ipAttribution=)]
    2020-08-19 ms5000000741733160

    👍🏻

    0

  5. 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Mon Aug 17 14:09:40 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043289, encodeId=c2681043289cc, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Mon Aug 17 14:09:40 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809655, encodeId=59528096553c, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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content=阅读, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3282551952, createdName=12543f43m99暂无昵称, createdTime=Mon Aug 17 11:10:35 CST 2020, time=2020-08-17, status=1, ipAttribution=)]
    2020-08-17 rayms

    一代神药#糖尿病#也把持不住了

    0

  6. 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Mon Aug 17 14:09:40 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043289, encodeId=c2681043289cc, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Mon Aug 17 14:09:40 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809655, encodeId=59528096553c, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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content=阅读, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3282551952, createdName=12543f43m99暂无昵称, createdTime=Mon Aug 17 11:10:35 CST 2020, time=2020-08-17, status=1, ipAttribution=)]
    2020-08-17 misszhang

    二甲双胍,神药!

    0

  7. 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content=阅读, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3282551952, createdName=12543f43m99暂无昵称, createdTime=Mon Aug 17 11:10:35 CST 2020, time=2020-08-17, status=1, ipAttribution=)]
    2020-08-17 misszhang

    谢谢MedSci提供最新的资讯

    0

  8. 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content=阅读, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3282551952, createdName=12543f43m99暂无昵称, createdTime=Mon Aug 17 11:10:35 CST 2020, time=2020-08-17, status=1, ipAttribution=)]
    2020-08-17 ms5000001908858550

    0

  9. 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    2020-08-17 Psycho.Dr Du

    终于找到神药的一点小bug了#学习#

    0

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    2020-08-17 12543f43m99暂无昵称

    阅读

    0

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