Diabetes Care:2型糖尿病患者:磺脲类药理差异是否影响心血管和低血糖风险?

2017-12-26 门鹏 环球医学

2017年11月,发表在《Diabetes Care》的一项由加拿大和德国科学家进行的研究,考察了磺脲类药理差异与心血管不良事件和低血糖事件的相关性。

2017年11月,发表在《Diabetes Care》的一项由加拿大和德国科学家进行的研究,考察了磺脲类药理差异与心血管不良事件和低血糖事件的相关性。

目的:磺脲类与心血管不良事件和低血糖风险增加相关,但不同药物之间的风险是否存在差异尚不清楚。根据胰腺特异性和治疗时间,研究人员评估了不同磺脲类药物之间心梗、缺血性卒中心血管死亡、全因死亡和重度低血糖的风险是否存在差异。

研究设计和方法:使用至Hospital Episodes Statistics和Office for National Statistics数据库的英国临床时间研究数据链接,研究人员于1998年至2013年开展了一项针对使用磺脲类单药治疗的2型糖尿病患者的队列研究。使用Cox比例风险模型,比较非胰腺特异性、长效磺脲类(格列本脲/格列美脲)与胰腺特异性、短效磺脲类(格列齐特/格列吡嗪/甲苯磺丁脲)。

结果:该队列纳入17604例起始使用磺脲类(平均[SD]随访1.2[1.5]年)。与胰腺特异性、短效磺脲类(15741例初始使用者)相比,非胰腺特异性、长效磺脲类(1863例初始使用者)与急性心梗(HR 0.86;CI 0.55~1.34)、缺血性卒中(HR 0.92;CI 0.59~1.45)、心血管死亡(HR 1.01;CI 0.72~1.40)或全因死亡风险增加不相关,但与重度低血糖风险增加相关(HR 2.83;CI 1.64~4.88)。

结论:与胰腺特异性、短效磺脲类格列本脲、格列吡嗪和甲苯磺丁脲相比,非胰腺特异性、长效磺脲类格列本脲和格列美脲与心血管不良事件风险增加不相关。然而,非胰腺特异性长效磺脲类格列本脲和格列美脲使低血糖的风险增加。

原始出处:
Douros A, Yin H, Yu OHY, et al.Pharmacologic Differences of Sulfonylureas and the Risk of Adverse Cardiovascular and Hypoglycemic Events.Diabetes Care. 2017 Nov;40(11):1506-1513. doi: 10.2337/dc17-0595. Epub 2017 Sep 1.

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NEJM:Empagliflozin可延缓2型糖尿病患者肾脏疾病的进展

糖尿病增加了不良心血管和肾脏事件的风险。在EMPA-REG观察性试验中,empagliflozin,钠-葡萄糖协同转运蛋白2的抑制剂,可以降低具有心血管事件高风险的2型糖尿病患者的重大不良心血管事件。研究人员想要确定empagliflozin对肾功能的长期影响,这是该试验二次微血管结果的预先规定的分析。研究人员随机分配2型糖尿病患者,估计其肾小球滤过率至少为每分钟30ml每1.73m2体表面积,每

Neurology:2型糖尿病患者预防痴呆:二甲双胍vs磺脲类药物

二甲双胍于2016年进行抗衰老的临床试验,试验结果可能让阿尔茨海默症和帕金森病等疾病成为遥远的回忆。2017年10月,发表在《Neurology》上的一项回顾性队列研究,考察了与磺脲类药物相比,二甲双胍是否与较低的痴呆发生率相关。

Diabetes Obes Metab:二甲双胍单药控制不佳的2型糖尿病患者:沙格列汀vs阿卡波糖

二甲双胍是目前全球应用最广的口服降糖药物之一,在糖尿病治疗中占有重要地位。但临床中也有一些单用二甲双胍控制不佳的2型糖尿病患者。2017年11月,发表在《Diabetes Obes Metab》的一项在中国35个地点进行的为期24周、多中心、随机、平行组、开放标签IV期研究调查了二甲双胍单药疗法控制不佳的中国2型糖尿病患者中沙格列汀vs阿卡波糖的有效性、安全性和耐受性。

Diabetologia:血清脂联素可预测2型糖尿病患者的骨折风险?

已经有报道称血清脂联素可影响一般人群的骨折风险。虽然2型糖尿病与骨折风险增加有关,但血清脂联素是否预测2型糖尿病患者的骨折仍不确定。近日,国际杂志 《Diabetologia》上在线发表一项关于血清脂联素预测2型糖尿病患者的骨折风险的研究。本研究的目的是前瞻性研究2型糖尿病患者血清脂联素与骨折风险之间的关系。

Diabetes Obes Metab:肥胖和超重的2型糖尿病患者减肥会降低HbA1c吗?

2017年,发表在《Diabetes Obes Metab》上的一项研究调查了在2型糖尿病患者减肥对糖化血红蛋白(HbA1c)的作用。研究结果显示:肥胖和超重的2型糖尿病患者体重的减轻会伴随着HbA1c降低,以剂量依赖的模式。