What is the phenotype of patients with gastrointestinal intolerance to metformin?
What is the phenotype of patients with gastrointestinal intolerance to metformin?
复制标题
DOI：
10.1016/j.diabet.2013.05.005
复制
发表时间：
2013-09-01
影响因子：
7.2
通讯作者：
Rousseau, M. F.
中科院分区：
文献类型：
--
作者：
Hermans, M. P.;Ahn, S. A.;Rousseau, M. F.
背景资料。-接受二甲双胍治疗的少数2型糖尿病(T2 DM)患者出现严重的胃肠道(GI)症状，导致停药，使他们失去了这种一线口服药物潜在的心脏保护多效性作用。目前，尚不清楚在不能使用二甲双胍的情况下治疗糖尿病是否会改变心血管结果。-从773例T2 DM门诊患者中，对83例因胃肠道不耐受而停用二甲双胍的患者(Met-Into病例)和332例年龄和性别匹配的二甲双胍耐受(Met-Tol)对照患者的心脏代谢表型进行了比较，病例与对照的比例为1：4。-平均年龄70岁(13岁)(男：女：46：54)。二甲双胍不耐受与大血管病变的发生率降低相关(P=0.0486)，这主要是由于冠心病的发生率较低(-34%；P=0.0374)。入院病例以A血型和A亚型Rh+较多见，相对增加分别为50%和66%(P=0.0039和P=0.0005)。在Met-Intol人群中，非右撇子的比例是后者的两倍(18%比9%；P=0.0262)，而且这组人的血清铁蛋白和低密度脂蛋白胆固醇水平也显著较高。他汀类药物和贝特类药物的使用率分别为66%、119%和48%/18%(他汀类药物P=0.0051)。而吸烟、糖尿病病程、糖化血红蛋白(1c)、体重指数、血压、腰围、脂肪量、内脏脂肪、肝脏脂肪变性、代谢综合征、EGFR、蛋白尿、勃起功能障碍和微血管病变在组间差异无统计学意义。-二甲双胍不耐受代表T2 DM患者的一种不可预见的表型，其特征是缺血性心脏病、左撇子、ABO组失衡和铁负荷低。(C)2013年爱思唯尔·马森公司。版权所有。
Background. - A substantial minority of type 2 diabetes mellitus (T2DM) patients treated with metformin develop severe gastrointestinal (GI) symptoms leading to drug discontinuation, depriving them of the potentially cardioprotective pleiotropic effects of this first-line oral agent. At present, it is unclear whether treating diabetes without being able to ever use metformin alters cardiovascular outcomes.Patients and methods. - From a population of 773 consecutive T2DM outpatients, the cardiometabolic phenotypes of 83 patients who discontinued metformin due to GI intolerance (Met-Intol cases) were compared with those of 332 age- and gender-matched metformin-tolerant (Met-Tol) controls, amounting to a case: control ratio of 1:4.Results. - Mean age (SD) was 70 (13) (male:female: 46:54). Metformin intolerance was associated with a reduced prevalence of macroangiopathy (P = 0.0486), mainly due to a lower prevalence of CAD (-34%; P = 0.0374). Met-Intol cases more often belonged to blood group A and subgroup A Rh+, with 50% and 66% relative increases (P = 0.0039 and P = 0.0005), respectively. There were twice as many non-right-handers among the Met-Intol (18% vs. 9%; P = 0.0262), and this group also had significantly higher serum ferritin and LDL cholesterol levels. Statins/fibrates were used by 66%119% of Met-Tol vs. 48%/18% of Met-Intol (P = 0.0051 for statins). On the other hand, there were no differences between groups as regards smoking, diabetes duration, HbA(1c), BMI, blood pressure, waist size, fat mass, visceral fat, liver steatosis, the metabolic syndrome, eGFR, albuminuria, erectile dysfunction and microangiopathy.Conclusion. - Intolerance to metformin represents an unforeseen phenotype in T2DM patients characterized by a low rate of ischaemic heart disease, left-handedness, ABO group imbalance and an iron load. (C) 2013 Elsevier Masson SAS. All rights reserved.