Diabetes Care:钠-葡萄糖共转运蛋白2抑制剂、二肽基肽酶4抑制剂和磺酰脲类药物对糖尿病酮症酸中毒风险的安全性比较

2022-02-28 从医路漫漫 MedSci原创

与二肽基肽酶4 (DPP-4)抑制剂和磺酰脲类药物相比,评估钠-葡萄糖共转运蛋白2 (SGLT2)抑制剂与糖尿病酮症酸中毒的关系。

目的:与二肽基肽酶4 (DPP-4)抑制剂和磺酰脲类药物相比,评估钠-葡萄糖共转运蛋白2 (SGLT2)抑制剂与糖尿病酮症酸中毒的关系。

研究设计和方法:我们进行了一项新用户活跃的比较队列研究,以检验两种两两比较:1)SGLT2抑制剂与DPP-4抑制剂,2)SGLT2抑制剂与磺酰脲类药物。主要结果是住院时出现的糖尿病酮症酸中毒。我们通过倾向评分匹配来调整混杂因素。我们使用带有稳健方差估计的Cox比例风险回归来估计风险比(HRs)和相应的95% ci,同时根据日历时间进行调整。

结果:在队列1中(n = 85,125的SGLT2抑制剂和n = 85,125的DPP-4抑制剂),糖尿病酮症酸中毒发生率每1000人年SGLT2抑制剂和DPP4抑制剂分别为6.0和4.3。在队列2中(n = 72436例SGLT2抑制剂和n = 72436例磺酰脲类药物),糖尿病酮症酸中毒发生率为每1000人年SGLT2抑制剂和磺酰脲类药物分别为6.3和4.5。在Cox比例风险回归模型中,与DPP-4抑制剂相比,使用SGLT2抑制剂与糖尿病酮症酸中毒发生率更高相关(调整后的HR [aHR] 1.63;95% CI 1.36, 1.96)和磺脲类药物(aHR 1.56;95%可信区间1.30,1.87)。

图1 钠-葡萄糖共转运体-2抑制剂与二肽基肽酶-4抑制剂(A组)和磺脲类药物(B组)新使用者配对前后倾向性评分的分布

表1 在2型糖尿病患者中,钠-葡萄糖共转运体-2抑制剂与二肽基肽酶-4抑制剂和磺脲类药物相比糖尿病酮症酸中毒的发生率

表2 与二肽基肽酶-4抑制剂和磺脲类药物比较的新使用钠-葡萄糖协同转运蛋白-2抑制剂的匹配2型糖尿病患者中的一部分患者的基线实验室测量

图2 代表风险比量表上联合最小关联强度的E值,未测量的混淆者必须使用SGLT2 is或DPP4is和糖尿病酮症酸中毒(A组)或磺脲类药物(B组),以完全解释观察到的1.63(SGLT2 is与DPP4is)和1.56(SGLT2 is与磺脲类药物)的治疗-结果风险比(SGLT2 is与DPP4is)和1.56(SGLT2 is与磺脲类药物)。

结论:在这项安全性比较研究中,与DPP-4抑制剂和磺酰脲类药物相比,SGLT2抑制剂治疗的2型糖尿病患者有更高的糖尿病酮症酸中毒发生率。临床医生应警惕这种关联。

原文出处: Dawwas GK,  Flory JH,  Hennessy S,et al.Comparative Safety of Sodium-Glucose Cotransporter 2 Inhibitors Versus Dipeptidyl Peptidase 4 Inhibitors and Sulfonylureas on the Risk of Diabetic Ketoacidosis.Diabetes Care 2022 Feb 11

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    2022-10-02 yzh409
  4. [GetPortalCommentsPageByObjectIdResponse(id=1902703, encodeId=1b2b1902e0353, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, 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=Sun Jul 31 10:56:28 CST 2022, time=2022-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1642332, encodeId=f0fc1642332ce, content=<a href='/topic/show?id=2e74e3891da' target=_blank style='color:#2F92EE;'>#磺酰脲类#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73891, encryptionId=2e74e3891da, topicName=磺酰脲类)], attachment=null, authenticateStatus=null, createdAvatar=null, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Thu Sep 22 11:56:28 CST 2022, time=2022-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1761853, encodeId=05231e6185362, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Fri Oct 28 18:56:28 CST 2022, time=2022-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2037552, 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Feb 28 17:56:28 CST 2022, time=2022-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1640066, encodeId=d6b6164006616, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, 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=Thu Oct 27 03:56:28 CST 2022, time=2022-10-27, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1902703, encodeId=1b2b1902e0353, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, 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=Sun Jul 31 10:56:28 CST 2022, time=2022-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1642332, encodeId=f0fc1642332ce, content=<a href='/topic/show?id=2e74e3891da' target=_blank style='color:#2F92EE;'>#磺酰脲类#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73891, encryptionId=2e74e3891da, topicName=磺酰脲类)], attachment=null, authenticateStatus=null, createdAvatar=null, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Thu Sep 22 11:56:28 CST 2022, time=2022-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1761853, encodeId=05231e6185362, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Fri Oct 28 18:56:28 CST 2022, time=2022-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2037552, 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  6. [GetPortalCommentsPageByObjectIdResponse(id=1902703, encodeId=1b2b1902e0353, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, 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=Sun Jul 31 10:56:28 CST 2022, time=2022-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1642332, encodeId=f0fc1642332ce, content=<a href='/topic/show?id=2e74e3891da' target=_blank style='color:#2F92EE;'>#磺酰脲类#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73891, encryptionId=2e74e3891da, topicName=磺酰脲类)], attachment=null, authenticateStatus=null, createdAvatar=null, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Thu Sep 22 11:56:28 CST 2022, time=2022-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1761853, encodeId=05231e6185362, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Fri Oct 28 18:56:28 CST 2022, time=2022-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2037552, encodeId=7b61203e55208, content=<a href='/topic/show?id=862b9553521' target=_blank style='color:#2F92EE;'>#酮症酸#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95535, encryptionId=862b9553521, topicName=酮症酸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c6262500044, createdName=1249862am72(暂无昵称), createdTime=Thu Oct 20 20:56:28 CST 2022, time=2022-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1676185, encodeId=ab7616e61851f, content=<a href='/topic/show?id=6bac955861e' target=_blank style='color:#2F92EE;'>#酸中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95586, encryptionId=6bac955861e, topicName=酸中毒)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c5dd27335710, createdName=hywen7335, createdTime=Mon Feb 28 17:56:28 CST 2022, time=2022-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1640066, encodeId=d6b6164006616, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, 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=Thu Oct 27 03:56:28 CST 2022, time=2022-10-27, status=1, ipAttribution=)]
    2022-09-22 jklm09
  7. [GetPortalCommentsPageByObjectIdResponse(id=1902703, encodeId=1b2b1902e0353, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, 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=Sun Jul 31 10:56:28 CST 2022, time=2022-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1642332, encodeId=f0fc1642332ce, content=<a href='/topic/show?id=2e74e3891da' target=_blank style='color:#2F92EE;'>#磺酰脲类#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73891, encryptionId=2e74e3891da, topicName=磺酰脲类)], attachment=null, authenticateStatus=null, createdAvatar=null, 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Feb 28 17:56:28 CST 2022, time=2022-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1640066, encodeId=d6b6164006616, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, 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=Thu Oct 27 03:56:28 CST 2022, time=2022-10-27, status=1, ipAttribution=)]
  8. 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  9. 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