Lancet diabetes endo:对于二甲双胍控制不佳的2型糖尿病患者,添加吡格列酮或磺脲类药物对患者心血管事件发生概率的影响对比。

2022-05-06 qinqiyun MedSci原创

对于单纯用二甲双胍不能合理控制血糖的2型糖尿病患者的最佳治疗方案仍处于争议中。

对于单纯用二甲双胍不能合理控制血糖的2型糖尿病患者的最佳治疗方案仍处于争议中。近日,Lancet子刊上发表了一篇文章,比较二甲双胍联合吡格列酮与二甲双胍联合磺脲类药物对于2型糖尿病患者在心血管事件上的长期效应。

研究人员进行一多中心联合的随机的临床试验,从意大利的57家糖尿病诊所招募50-75岁用二甲双胍单一疗法(每日2-3g)不能合理控制血糖的2型糖尿病患者,按1:1随机分组,并根据地点和既往心血管事件分层。在服用二甲双胍的基础上,分别添加吡格列酮(15-45mg)或磺脲类药物(格列本脲 5-15mg、格列美脲 2-6mg或格列齐特 30-120mg)。主要评估结局:首次出现的全因死亡、非致命性心肌梗死、非致命性中风或急性冠状动脉硬化。

2008年9月18日-2014年1月15日期间,共招募3028名患者,1535人分至吡格列酮组,1493人分至磺脲类组(格列本脲24人、格列美脲723人、格列齐特745人)。起始时,335位(11%)受试者既往发生过心血管事件。试验于随访中位时间57.3个月时终止。服用吡格列酮和磺脲类药物的患者中分别有105位和108位患者出现心血管事件(危险比0.96,95% CI 0.74-1.26,p=0.79)。吡格列酮组低血糖的患者较磺脲类组少(148[10%] vs 508[34%],p<0.0001)。两组中均有中度体重增加(平均少于2kg)。两治疗组心衰、膀胱癌和骨折的概率没有明显差异。

在二甲双胍治疗的基础上,添加吡格列酮或磺脲类药物对于心血管事件的发生的影响没有差异。两种药物均可根据效果和副作用适当用于治疗糖尿病。

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time=2017-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244093, encodeId=541024409336, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K46ZAxBHmHsph32KkfsWGwmickB6RsCUD8KruE4vo5CpvXfdu16GBpp4ibh6WJu1o9iatP1LWKDmvmic/0, createdBy=be6f1940165, createdName=1e0ece0dm09(暂无匿称), createdTime=Fri Sep 15 00:04:17 CST 2017, time=2017-09-15, status=1, ipAttribution=)]
    2018-05-12 howi
  5. [GetPortalCommentsPageByObjectIdResponse(id=1643794, encodeId=65d51643e94a3, content=<a href='/topic/show?id=6236895092b' target=_blank style='color:#2F92EE;'>#血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89509, encryptionId=6236895092b, topicName=血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99523187183, createdName=hukaixun, createdTime=Fri Jan 12 03:00:00 CST 2018, time=2018-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1640140, encodeId=264c164014051, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, 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time=2017-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244093, encodeId=541024409336, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K46ZAxBHmHsph32KkfsWGwmickB6RsCUD8KruE4vo5CpvXfdu16GBpp4ibh6WJu1o9iatP1LWKDmvmic/0, createdBy=be6f1940165, createdName=1e0ece0dm09(暂无匿称), createdTime=Fri Sep 15 00:04:17 CST 2017, time=2017-09-15, status=1, ipAttribution=)]
    2018-08-29 docwu2019
  6. 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time=2017-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244093, encodeId=541024409336, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K46ZAxBHmHsph32KkfsWGwmickB6RsCUD8KruE4vo5CpvXfdu16GBpp4ibh6WJu1o9iatP1LWKDmvmic/0, createdBy=be6f1940165, createdName=1e0ece0dm09(暂无匿称), createdTime=Fri Sep 15 00:04:17 CST 2017, time=2017-09-15, status=1, ipAttribution=)]
  7. 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    2017-09-15 1e0ece0dm09(暂无匿称)

    谢谢分享

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2017年欧洲糖尿病年会召开在即,此间将公布多项随机化临床试验结果,其中有三项心血管终点试验最值得关注,即ACE研究(阿卡波糖vs安慰剂)、EXSCEL研究(艾塞那肽vs安慰剂)以及TOSCA IT研究(噻唑烷二酮vs磺脲类药物)。这三项研究结果对于进一步了解降糖药物的心血管效应具有重要意义。

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肝脏在维持血糖稳态中起着关键的作用,肝葡萄糖代谢受损与2型糖尿病的发生相关。本研究中,研究人员采用RNA测序对比了糖尿病db/db小鼠及正常db/+小鼠肝脏转录组的表达谱,并确定了218个差异表达的基因。在这其中,db/db小鼠肝脏中3个lncRNA表达下调,且H19是下调最为明显的lncRNA。H19的表达与糖酵解和糖异生通路相关基因的表达显著相关,表明肝脏H19的表达水平可直接或间接地调节它们

Diabetic Med:医生与2型糖尿病患者讨论诊断时所面临的困难

近日,国际杂志 《Diabetic Medicine》上在线发表一项关于医生与2型糖尿病患者讨论诊断时所面临的困难。调查医生在诊断2型糖尿病时与患者对话的回顾经验,因为当时的医生与患者沟通可能会影响患者随后的自我照顾和结果。

Diabetes Care:2型糖尿病的新型预测标志物

人类维生素E结合糖蛋白afamin主要在肝脏中表达,并与常见和偶发性代谢综合征相关。这些研究数据符合转基因小鼠的观察结果。近期,一项发表在杂志Diabetes Care上的研究调查了afamin的浓度是否与糖尿病前期,2型糖尿病和胰岛素抵抗(IR)有关。此项研究对8项前瞻性队列研究的个体水平基线(n = 20,136)和随访资料(n = 14,017)进行了调查。使用随机效应荟萃分析结合了研究数据