Heart：治疗2型糖尿病选择胰岛素还是胰高血糖素样肽-1类似物？

2016-09-24 MedSci MedSci原创

研究表明在肥胖的2型糖尿病患者中，通过口服胰高血糖素样肽-1类似物强化双药治疗与在日常临床实践中降低主要不良心脏事件相关，相对于胰岛素，胰高血糖素样肽-1类似物更应该成为双药治疗后的第三个降血药物。

近日，心脏病领域权威杂志《Heart》上发表了英国诺丁汉大学医学院Uchenna医生关于2型糖尿病患者接受二甲双胍和磺脲类药物联合治疗失败后降糖药物选择的问题的研究，是选择胰岛素还是胰高血糖素样肽-1类似物进行强化治疗？2型糖尿病患者心血管事件和死亡率说了算。

研究者采用了回顾性队列研究的发法，纳入了2006年至2014年用2003例二甲双胍和磺脲类药物联合治疗失败，而且是初次使用胰岛素（n=1584）或胰高血糖素样肽-1类似物（n=419）进行强化治疗的患者，平均年龄为52.8±14.1 岁。通过比较两组之间主要不良心脏事件（非致命性心肌梗死、非致死性卒中和全因死亡率）的发生风险，随访5 年（6614人/年），通过倾向得分匹配分析和Cox比例风险模型进行分析。总的来说，发生主要不良心脏事件的数量在胰岛素组和胰高血糖素样肽-1类似物组分别为231例和11例（44.5 vs 7.7每1000人每年，调整后的HR为0.27；95%可信区间为0.14~0.53；P＜0.0001）。与胰高血糖素样肽-1类似物组比，胰岛素可明显增加体重（1.78 vs -3.93kg；P＜0.0001），但是两组糖化血红蛋白A1C减少程度一致（-1.29 vs -0.98；P=0.156）。对肥胖患者（身体质量指数大于30 kg/m²）进行亚组分析，发现两组分别有84和11例复合终点事件发生（38.6 vs 8.1每1000人/年；调整后的HR为0.31；95%可信区间0.16~0.61；P=0.001）。

研究表明在肥胖的2型糖尿病患者中，通过口服胰高血糖素样肽-1类似物强化双药治疗与在日常临床实践中降低主要不良心脏事件相关，相对于胰岛素，胰高血糖素样肽-1类似物更应该成为双药治疗后的第三个降血药物。

原始出处：

Uchenna Anyanwagu,et al. Cardiovascular events and all-cause mortality with insulin versus glucagon-like peptide-1 analogue in type 2 diabetes. Heart. 2016. doi:10.1136/heartjnl-2015-309164

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2017-06-05 liuquanmn

#胰高血糖素样肽-1#

33 0
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2016-11-24 baoya

#胰岛#

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2016-10-12 jyzxjiangqin

科学用药治疗2型糖尿病。

44 0
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2016-10-01 doctorJiangchao

继续关注

51 0
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2016-09-26 hbwxf

#高血糖#

27 0
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2016-09-26 zhaojie88

#ART#

25 0
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2016-09-26 sjzlzc009

#胰高血糖素#

24 0
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2016-09-26 slcumt

#HEART#

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Heart：治疗2型糖尿病选择胰岛素还是胰高血糖素样肽-1类似物？

本文系梅斯医学（MedSci）原创编译整理，转载需授权！

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