Diabetes Obes Metab:口服降糖药强化治疗的更佳开始时机?

2022-06-09 顾歆纯 环球医学资讯

2017年7月,发表在《Diabetes Obes Metab》的一项由美国科学家进行的个体患者模拟研究考察了血糖控制较差的患者中,口服抗糖尿病药物(OAD)强化治疗的延迟与微血管和大血管事件的风险。

2017年7月,发表在《Diabetes Obes Metab》的一项由美国科学家进行的个体患者模拟研究考察了血糖控制较差的患者中,口服抗糖尿病药物(OAD)强化治疗的延迟与微血管和大血管事件的风险。

目的:旨在使用阿基米德模型来评估OAD强化治疗的延迟对血糖控制和5年及20年长期结局的影响。

材料和方法:使用真实世界的数据,研究者模拟了一个二甲双胍治疗且无胰岛素使用史的糖化血红蛋白≥8%的假设患者队列。基于基线时服用的OAD数量,将队列分为3层。在强化治疗顺序中第一个添加的为磺脲类药物,接着为二肽基肽酶-4抑制剂,最后为噻唑烷二酮。基于观察到的和推测的强化时间,临床情景包括未延迟或延迟。

结果:1年时,未延迟强化的患者的糖化血红蛋白为6.8%,延迟强化的为8.2%。对于未延迟vs延迟,5年时,严重不良心脏事件、心肌梗死心衰和截肢的风险分别降低了19.0%、25.0%、13.7%和20.4%。然而,未延迟患者的严重低血糖风险增加到19%,延迟患者增加到12.5%。20年时,结果趋势与5年时的相似。

结论:根据指南推荐,OAD治疗的强化时间会造成糖化血红蛋白较多的降低,以及并发症风险的降低,但是未延迟会比延迟强化者具有较高的低血糖风险。这些结果强调了及时强化治疗对长期结局的潜在影响。

(专家点评:多项大规模临床试验的结果均表明,糖尿病前期强化降糖对长期心血管和全因死亡率有很大获益,且该作用不受后期血糖控制情况的影响。该研究通过模型计算得到了相似的结果。因此糖尿病患者必须强调前期强化降糖。)

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    2017-11-17 guojianrong
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    2018-01-11 docwu2019
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    2017-11-08 一闲
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  7. [GetPortalCommentsPageByObjectIdResponse(id=1888438, encodeId=2a0c1888438a9, content=<a href='/topic/show?id=d56611584ec' target=_blank style='color:#2F92EE;'>#Meta#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11584, encryptionId=d56611584ec, topicName=Meta)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, createdName=guojianrong, createdTime=Fri Nov 17 06:38:00 CST 2017, time=2017-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1640169, encodeId=41851640169cd, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Fri Jun 01 15:38:00 CST 2018, time=2018-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1902738, encodeId=55451902e38e8, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Sat Nov 04 05:38:00 CST 2017, time=2017-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1761943, encodeId=14041e6194324, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Thu Jan 11 18:38:00 CST 2018, time=2018-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1897020, encodeId=f304189e02075, content=<a href='/topic/show?id=4a391158248' target=_blank style='color:#2F92EE;'>#MET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11582, encryptionId=4a391158248, topicName=MET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc139, createdName=一闲, createdTime=Wed Nov 08 08:38:00 CST 2017, time=2017-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1270942, encodeId=59bb12e0942ca, content=<a href='/topic/show?id=4066981e99e' target=_blank style='color:#2F92EE;'>#降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98179, encryptionId=4066981e99e, topicName=降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Thu Jul 27 06:38:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1312779, encodeId=4aa41312e7905, content=<a href='/topic/show?id=59af3824946' target=_blank style='color:#2F92EE;'>#口服降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38249, encryptionId=59af3824946, topicName=口服降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Thu Jul 27 06:38:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1554091, encodeId=a97e155409181, content=<a href='/topic/show?id=394d5013059' target=_blank style='color:#2F92EE;'>#强化治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50130, encryptionId=394d5013059, topicName=强化治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bcc714501479, createdName=huanbaofeng, createdTime=Thu Jul 27 06:38:00 CST 2017, time=2017-07-27, status=1, ipAttribution=)]
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