Mortality and other important diabetes-related outcomes with insulin vs other antihyperglycemic therapies in type 2 diabetes.
Mortality and other important diabetes-related outcomes with insulin vs other antihyperglycemic therapies in type 2 diabetes.
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DOI：
10.1210/jc.2012-3042
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发表时间：
2013-02
期刊：
影响因子：
--
通讯作者：
Morgan CL
中科院分区：
文献类型：
--
作者：
Currie CJ;Poole CD;Evans M;Peters JR;Morgan CL
胰岛素治疗2型糖尿病(T2 DM)的安全性最近受到了审查。这项研究的目的是描述T2 DM患者降糖治疗相关不良事件的风险。这是一项回溯性队列研究，使用了2000-2010年间英国全科医学研究数据库中的数据。84622例2型糖尿病患者接受5种降糖方案中的一种：二甲双胍、磺脲类药物、胰岛素类药物、二甲双胍+磺脲类药物、胰岛素+二甲双胍类药物。暴露期为105123个。测量第一次重大心脏不良事件、第一次癌症或死亡率的风险。次要结果包括这些个体成分和微血管并发症。在同一模型中，以二甲双胍为参照物，磺脲类药物治疗(1.436，95%可信区间1.354-1.523)、胰岛素单一治疗(1.808，95%可信区间1.630-2.005)和胰岛素加二甲双胍治疗(1.309，95%可信区间1.150-1.491)的主要终点的调整风险比显著增加。在糖化血红蛋白/发病亚组中，接受胰岛素单一治疗的患者的主要结果的AHRS范围从1.469(95%可信区间0.978-2.206)到2.644(95%可信区间1.896-3.687)。对于所有的次要结果，单一胰岛素治疗增加了AHRS：心肌梗死(1.954，95%CI 1.479-2.583)，主要心脏不良事件(1.736，95%CI 1.441-2.092)，中风(1.432，95%CI 1.159-1.771)，肾脏并发症(3.504，95%CI 2.718-4.518)，神经病变(2.146，95%CI 1.832-2.514)，眼睛并发症(1.171，95%CI 1.057-1.298)，癌症(1.437，95%可信区间1.234~1.674)或全因死亡率(2.197，95%可信区间1.983~2.434)。当直接比较时，胰岛素单一疗法的AHRS在主要终点和全因死亡率方面高于所有其他方案。在T2 DM患者中，外源性胰岛素治疗与糖尿病相关并发症、癌症和全因死亡的风险增加相关。在解释这些结果时，应考虑治疗组之间基线特征的差异。
The safety of insulin in the treatment of type 2 diabetes mellitus (T2DM) has recently undergone scrutiny. The objective of the study was to characterize the risk of adverse events associated with glucose-lowering therapies in people with T2DM. This was a retrospective cohort study using data from the UK General Practice Research Database, 2000–2010. Patients comprised 84 622 primary care patients with T2DM treated with one of five glucose-lowering regimens: metformin monotherapy, sulfonylurea monotherapy, insulin monotherapy, metformin plus sulfonylurea combination therapy, and insulin plus metformin combination therapy. There were 105 123 exposure periods. The risk of the first major adverse cardiac event, first cancer, or mortality was measured. Secondary outcomes included these individual constituents and microvascular complications. In the same model, and using metformin monotherapy as the referent, the adjusted hazard ratio (aHR) for the primary end point was significantly increased for sulfonylurea monotherapy (1.436, 95% confidence interval [CI] 1.354–1.523), insulin monotherapy (1.808, 95% CI 1.630–2.005), and insulin plus metformin (1.309, 95% CI 1.150–1.491). In glycosylated hemoglobin/morbidity subgroups, patients treated with insulin monotherapy had aHRs for the primary outcome ranging from 1.469 (95% CI 0.978–2.206) to 2.644 (95% CI 1.896–3.687). For all secondary outcomes, insulin monotherapy had increased aHRs: myocardial infarction (1.954, 95% CI 1.479–2.583), major adverse cardiac events (1.736, 95% CI 1.441–2.092), stroke (1.432, 95% CI 1.159–1.771), renal complications (3.504, 95% CI 2.718–4.518), neuropathy (2.146, 95% CI 1.832–2.514), eye complications (1.171, 95% CI 1.057–1.298), cancer (1.437, 95% CI 1.234–1.674), or all-cause mortality (2.197, 95% CI 1.983–2.434). When compared directly, aHRs were higher for insulin monotherapy vs all other regimens for the primary end point and all-cause mortality. In people with T2DM, exogenous insulin therapy was associated with an increased risk of diabetes-related complications, cancer, and all-cause mortality. Differences in baseline characteristics between treatment groups should be considered when interpreting these results.
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影响因子：
16.2
作者：
American Diabetes Association
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American Diabetes Association
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