BMJ:卡格列净治疗导致的下肢截肢不良事件风险评估

2020-08-30 MedSci原创 MedSci原创

总体而言,与GLP-1激动剂相比,卡格列净使用者的下肢截肢风险未见显著增加

SGLT2抑制剂是近年来小分子糖尿病治疗药物的研究热点,其在降血糖的同时可降低糖尿病患者血管及肾脏不良事件的风险,但CANVAS 研究发现,其代表药物卡格列净卡格列净导致患者下肢截肢风险是安慰剂的2倍。近日研究人员考察了新近使用卡格列净患者的风险,并根据年龄及心血管疾病进行分层。
 
 
研究人员收集了2013-17年间,2个商业保险数据库的索赔数据,以新接受GLP-1激动剂患者数据为对照,比较4组患者每1000随访年中的下肢截肢风险,第1组参与者为65岁以下,无基线心血管疾病患者;第2组为65岁以下,存在基线心血管疾病患者;第3组为65岁以上,无基线心血管疾病患者;第4组为65岁以上,存在基线心血管疾病患者。
 
研究收集310840名患者数据。与GLP-1激动剂相比,每1000患者随访年中,各组卡格列净患者的下肢截肢风险如下:第1组为1.09、第2组为1.18、第3组为1.30、第4组为1.73。
 
 
总体而言,与GLP-1激动剂相比,卡格列净使用者的下肢截肢风险未见显著增加,但对于65岁以上且存在基线心血管疾病的患者,其截肢风险增加但不显著,6个月的疗程中每10000名患者中,额外导致18名患者截肢。
 
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  1. [GetPortalCommentsPageByObjectIdResponse(id=2007405, encodeId=ec6e200e40565, content=<a href='/topic/show?id=609c2048199' target=_blank style='color:#2F92EE;'>#不良事件风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20481, encryptionId=609c2048199, topicName=不良事件风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=66962500501, createdName=yige2004, createdTime=Fri Jan 01 10:38:10 CST 2021, time=2021-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1849087, encodeId=3420184908e29, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Thu Jul 15 07:38:10 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=889060, encodeId=27bb8890604b, content=学习了,如果有中国数据就更好了, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2018/12/05/9151d1e89e73add788e7d96c55fb5dec.jpg, createdBy=dcfd2497546, createdName=124902dfm95暂无昵称, createdTime=Tue Sep 29 06:50:12 CST 2020, time=2020-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1388208, encodeId=96c7138820833, content=<a href='/topic/show?id=e51454180b6' target=_blank style='color:#2F92EE;'>#截肢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54180, encryptionId=e51454180b6, topicName=截肢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c1292500019, createdName=124984edm22暂无昵称, createdTime=Tue Sep 01 01:38:10 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=881025, encodeId=d24f88102544, content=与GLP-1激动剂相比,<a href='/topic/show?id=2d6f3651388' target=_blank style='color:#2F92EE;'>#卡格列净#</a>使用者的<a href='/topic/show?id=2b692018568' target=_blank style='color:#2F92EE;'>#下肢截肢#</a>风险未见显著增加,但对于65岁以上且存在基线心血管疾病的患者,其截肢风险增加但不显著,6个月的疗程中每10000名患者中,额外导致18名患者截肢,问题在于是什么原因?是不是SGLT2i类药物容易引发感染?, beContent=null, objectType=article, channel=null, level=null, likeNumber=150, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36513, encryptionId=2d6f3651388, topicName=卡格列净), TopicDto(id=20185, encryptionId=2b692018568, topicName=下肢截肢)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Aug 30 19:33:21 CST 2020, time=2020-08-30, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=2007405, encodeId=ec6e200e40565, content=<a href='/topic/show?id=609c2048199' target=_blank style='color:#2F92EE;'>#不良事件风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20481, encryptionId=609c2048199, topicName=不良事件风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=66962500501, createdName=yige2004, createdTime=Fri Jan 01 10:38:10 CST 2021, time=2021-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1849087, encodeId=3420184908e29, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Thu Jul 15 07:38:10 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=889060, encodeId=27bb8890604b, content=学习了,如果有中国数据就更好了, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2018/12/05/9151d1e89e73add788e7d96c55fb5dec.jpg, createdBy=dcfd2497546, createdName=124902dfm95暂无昵称, createdTime=Tue Sep 29 06:50:12 CST 2020, time=2020-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1388208, encodeId=96c7138820833, content=<a href='/topic/show?id=e51454180b6' target=_blank style='color:#2F92EE;'>#截肢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54180, encryptionId=e51454180b6, topicName=截肢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c1292500019, createdName=124984edm22暂无昵称, createdTime=Tue Sep 01 01:38:10 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=881025, encodeId=d24f88102544, content=与GLP-1激动剂相比,<a href='/topic/show?id=2d6f3651388' target=_blank style='color:#2F92EE;'>#卡格列净#</a>使用者的<a href='/topic/show?id=2b692018568' target=_blank style='color:#2F92EE;'>#下肢截肢#</a>风险未见显著增加,但对于65岁以上且存在基线心血管疾病的患者,其截肢风险增加但不显著,6个月的疗程中每10000名患者中,额外导致18名患者截肢,问题在于是什么原因?是不是SGLT2i类药物容易引发感染?, beContent=null, objectType=article, channel=null, level=null, likeNumber=150, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36513, encryptionId=2d6f3651388, topicName=卡格列净), TopicDto(id=20185, encryptionId=2b692018568, topicName=下肢截肢)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Aug 30 19:33:21 CST 2020, time=2020-08-30, status=1, ipAttribution=)]
    2021-07-15 gaoxiaoe
  3. [GetPortalCommentsPageByObjectIdResponse(id=2007405, encodeId=ec6e200e40565, content=<a href='/topic/show?id=609c2048199' target=_blank style='color:#2F92EE;'>#不良事件风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20481, encryptionId=609c2048199, topicName=不良事件风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=66962500501, createdName=yige2004, createdTime=Fri Jan 01 10:38:10 CST 2021, time=2021-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1849087, encodeId=3420184908e29, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Thu Jul 15 07:38:10 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=889060, encodeId=27bb8890604b, content=学习了,如果有中国数据就更好了, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2018/12/05/9151d1e89e73add788e7d96c55fb5dec.jpg, createdBy=dcfd2497546, createdName=124902dfm95暂无昵称, createdTime=Tue Sep 29 06:50:12 CST 2020, time=2020-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1388208, encodeId=96c7138820833, content=<a href='/topic/show?id=e51454180b6' target=_blank style='color:#2F92EE;'>#截肢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54180, encryptionId=e51454180b6, topicName=截肢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c1292500019, createdName=124984edm22暂无昵称, createdTime=Tue Sep 01 01:38:10 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=881025, encodeId=d24f88102544, content=与GLP-1激动剂相比,<a href='/topic/show?id=2d6f3651388' target=_blank style='color:#2F92EE;'>#卡格列净#</a>使用者的<a href='/topic/show?id=2b692018568' target=_blank style='color:#2F92EE;'>#下肢截肢#</a>风险未见显著增加,但对于65岁以上且存在基线心血管疾病的患者,其截肢风险增加但不显著,6个月的疗程中每10000名患者中,额外导致18名患者截肢,问题在于是什么原因?是不是SGLT2i类药物容易引发感染?, beContent=null, objectType=article, channel=null, level=null, likeNumber=150, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36513, encryptionId=2d6f3651388, topicName=卡格列净), TopicDto(id=20185, encryptionId=2b692018568, topicName=下肢截肢)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Aug 30 19:33:21 CST 2020, time=2020-08-30, status=1, ipAttribution=)]
    2020-09-29 124902dfm95暂无昵称

    学习了,如果有中国数据就更好了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2007405, encodeId=ec6e200e40565, content=<a href='/topic/show?id=609c2048199' target=_blank style='color:#2F92EE;'>#不良事件风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20481, encryptionId=609c2048199, topicName=不良事件风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=66962500501, createdName=yige2004, createdTime=Fri Jan 01 10:38:10 CST 2021, time=2021-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1849087, encodeId=3420184908e29, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Thu Jul 15 07:38:10 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=889060, encodeId=27bb8890604b, content=学习了,如果有中国数据就更好了, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2018/12/05/9151d1e89e73add788e7d96c55fb5dec.jpg, createdBy=dcfd2497546, createdName=124902dfm95暂无昵称, createdTime=Tue Sep 29 06:50:12 CST 2020, time=2020-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1388208, encodeId=96c7138820833, content=<a href='/topic/show?id=e51454180b6' target=_blank style='color:#2F92EE;'>#截肢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54180, encryptionId=e51454180b6, topicName=截肢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c1292500019, createdName=124984edm22暂无昵称, createdTime=Tue Sep 01 01:38:10 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=881025, encodeId=d24f88102544, content=与GLP-1激动剂相比,<a href='/topic/show?id=2d6f3651388' target=_blank style='color:#2F92EE;'>#卡格列净#</a>使用者的<a href='/topic/show?id=2b692018568' target=_blank style='color:#2F92EE;'>#下肢截肢#</a>风险未见显著增加,但对于65岁以上且存在基线心血管疾病的患者,其截肢风险增加但不显著,6个月的疗程中每10000名患者中,额外导致18名患者截肢,问题在于是什么原因?是不是SGLT2i类药物容易引发感染?, beContent=null, objectType=article, channel=null, level=null, likeNumber=150, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36513, encryptionId=2d6f3651388, topicName=卡格列净), TopicDto(id=20185, encryptionId=2b692018568, topicName=下肢截肢)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Aug 30 19:33:21 CST 2020, time=2020-08-30, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=2007405, encodeId=ec6e200e40565, content=<a href='/topic/show?id=609c2048199' target=_blank style='color:#2F92EE;'>#不良事件风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20481, encryptionId=609c2048199, topicName=不良事件风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=66962500501, createdName=yige2004, createdTime=Fri Jan 01 10:38:10 CST 2021, time=2021-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1849087, encodeId=3420184908e29, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Thu Jul 15 07:38:10 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=889060, encodeId=27bb8890604b, content=学习了,如果有中国数据就更好了, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2018/12/05/9151d1e89e73add788e7d96c55fb5dec.jpg, createdBy=dcfd2497546, createdName=124902dfm95暂无昵称, createdTime=Tue Sep 29 06:50:12 CST 2020, time=2020-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1388208, encodeId=96c7138820833, content=<a href='/topic/show?id=e51454180b6' target=_blank style='color:#2F92EE;'>#截肢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54180, encryptionId=e51454180b6, topicName=截肢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c1292500019, createdName=124984edm22暂无昵称, createdTime=Tue Sep 01 01:38:10 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=881025, encodeId=d24f88102544, content=与GLP-1激动剂相比,<a href='/topic/show?id=2d6f3651388' target=_blank style='color:#2F92EE;'>#卡格列净#</a>使用者的<a href='/topic/show?id=2b692018568' target=_blank style='color:#2F92EE;'>#下肢截肢#</a>风险未见显著增加,但对于65岁以上且存在基线心血管疾病的患者,其截肢风险增加但不显著,6个月的疗程中每10000名患者中,额外导致18名患者截肢,问题在于是什么原因?是不是SGLT2i类药物容易引发感染?, beContent=null, objectType=article, channel=null, level=null, likeNumber=150, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36513, encryptionId=2d6f3651388, topicName=卡格列净), TopicDto(id=20185, encryptionId=2b692018568, topicName=下肢截肢)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Aug 30 19:33:21 CST 2020, time=2020-08-30, status=1, ipAttribution=)]
    2020-08-30 lovetcm

    与GLP-1激动剂相比,#卡格列净#使用者的#下肢截肢#风险未见显著增加,但对于65岁以上且存在基线心血管疾病的患者,其截肢风险增加但不显著,6个月的疗程中每10000名患者中,额外导致18名患者截肢,问题在于是什么原因?是不是SGLT2i类药物容易引发感染?

    0

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在这个基于社区的大型样本中,A1C水平正常偏高是COVID-19的危险因素。血糖调节可能在COVID-19患者的免疫反应中起关键作用。

Nature:人造胰岛有望攻克糖尿病 

缺乏PD-L1的人造胰岛类器官的功能会逐渐丧失,导致机体血糖水平的增加,而PD-L1+的人造胰岛类器官则可以维持血糖稳态超过50天。

JAMA Oncol:15万人随访30年发现,糖尿病患者体重减轻,与胰腺癌风险增至2.8-6倍有关

近期,哈佛大学陈曾熙公共卫生学院团队发表的一项分析显示:新发糖尿病、有糖尿病史或是体重减轻,都与胰腺癌的发病风险上升有关。

NEJM:人工胰腺系统用于I型糖尿病患儿的治疗

近日研究人员考察了人工胰腺闭环胰岛素给药系统对I型糖尿病儿童血糖的影响。

Am J Resp Crit Care:睡眠呼吸障碍和失眠与高血压和糖尿病的关联

SDB与高血压和糖尿病有关。失眠与高血压有关。这些结果支持将睡眠障碍作为预防和减少疾病的可改变靶标的重要性。