Prescription of oral hypoglycemic agents for patients with type 2 diabetes mellitus: A retrospective cohort study using a Japanese hospital database.
Prescription of oral hypoglycemic agents for patients with type 2 diabetes mellitus: A retrospective cohort study using a Japanese hospital database.
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DOI：
10.1111/jdi.12567
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发表时间：
2017-03
影响因子：
3.2
通讯作者：
Yanase T
中科院分区：
文献类型：
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作者：
Tanabe M;Motonaga R;Terawaki Y;Nomiyama T;Yanase T
在西方国家的2型糖尿病的治疗算法中，双胍类药物被推荐为一线药物。在日本，有各种口服降糖药(OHA)可用，但处方模式尚不清楚。研究1和研究2中分别有7,108和2,655名2型糖尿病患者的数据来自于医学数据视觉数据库(2008-2013)。研究1中未考虑心血管疾病病史，但在研究2中。研究了OHA的初始选择、坚持使用、2年内对糖化血红蛋白水平的影响以及OHA的第二选择。在研究1中，与其他OHA相比，α-葡萄糖苷酶抑制剂格列奈和噻唑烷二酮在糖化血红蛋白相对较低的病例中优先使用。OHAs最常用的两个第一处方是双胍和二肽基肽酶-4抑制剂，最大的依从性是α-葡萄糖苷酶抑制剂。在连续使用单一OHA治疗2年的患者中，二肽基肽酶-4抑制剂对糖化血红蛋白水平的改善最大。作为头两年在第一个OHA中添加的第二个OHA，二肽基肽酶-4抑制剂最常被选择，特别是当双胍是第一个OHA时。在研究2中，以有心血管疾病病史的患者为目标，在OHA的第一选择、依从性和第二选择中观察到与研究1类似的倾向。即使在日本的2型糖尿病患者中，西方的算法似乎也在某种程度上受到了尊重。OHA的选择似乎不受心血管疾病病史的影响。
In treatment algorithms of type 2 diabetes mellitus in Western countries, biguanides are recommended as first‐line agents. In Japan, various oral hypoglycemic agents (OHAs) are available, but prescription patterns are unclear. Data of 7,108 and 2,655 type 2 diabetes mellitus patients in study 1 and study 2, respectively, were extracted from the Medical Data Vision database (2008–2013). Cardiovascular disease history was not considered in study 1, but was in study 2. Initial choice of OHA, adherence to its use, effect on glycated hemoglobin levels for 2 years and the second choice of OHA were investigated. In study 1, α‐glucosidase inhibitor, glinide and thiazolidinedione were preferentially medicated in relatively lower glycated hemoglobin cases compared with other OHAs. The two most prevalent first prescriptions of OHAs were biguanides and dipeptidyl peptidase‐4 inhibitors, and the greatest adherence was for α‐glucosidase inhibitors. In patients treated continuously with a single OHA for 2 years, improvement in glycated hemoglobin levels was greatest for dipeptidyl peptidase‐4 inhibitors. As a second OHA added to the first OHA during the first 2 years, dipeptidyl peptidase‐4 inhibitors were chosen most often, especially if a biguanide was the first OHA. In study 2, targeting patients with a cardiovascular disease history, a similar tendency to study 1 was observed in the first choice of OHA, adherence and the second choice of OHA. Even in Japanese type 2 diabetes mellitus patients, a Western algorithm seems to be respected to some degree. The OHA choice does not seem to be affected by a cardiovascular disease history.