Intensification of antihyperglycemic therapy among patients with incident diabetes: a Surveillance Prevention and Management of Diabetes Mellitus (SUPREME-DM) study.
Intensification of antihyperglycemic therapy among patients with incident diabetes: a Surveillance Prevention and Management of Diabetes Mellitus (SUPREME-DM) study.
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糖尿病患者强化抗高血糖治疗：糖尿病监测预防和管理 (SUPREME-DM) 研究。
DOI：
10.1002/pds.3610
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发表时间：
2014
影响因子：
2.6
通讯作者：
Pathak,Ra
中科院分区：
文献类型：
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作者：
Raebel,MarshaA;Ellis,JenniferL;Schroeder,EmilyB;Xu,Stanley;O'Connor,PatrickJ;Segal,JodiB;Butler,MelissaG;Schmittdiel,JulieA;Kirchner,HLester;Goodrich,GlennK;Lawrence,JeanM;Nichols,GregoryA;Newton,KatherineM;Pathak,Ra
目的：降糖强化治疗在偶发糖尿病患者中的应用尚不完全清楚。我们描述了在偶发糖尿病患者中口服降糖药物开始后一年的第一次强化。方法：这项回顾性队列研究涉及11个美国卫生系统，包括2005年至2009年间确诊为偶发糖尿病的成年人，他们在确诊糖尿病后6个月内开始口服降糖单药或联合治疗。我们确定了强化，定义为增加指标药物剂量，添加另一种口服药物，或在初始降糖后31-365天切换到/添加胰岛素。Cox回归用于评估患者、时间和系统协变量的强化，并将糖化血红蛋白（HbA1c）作为时间相关变量进行调整。结果41 233例患者中，在6个月和12个月内加强治疗的分别占33.5%和45.3%。第一次强化在指数用药剂量增加时最常见（78%），在胰岛素时最不常见（<1%）。HbA1c%与强化密切相关（与HbA1c < 6.5%相比，HbA1c 6.5%至<7%、7%至<7.5%、7.5至<8%和≥8%的校正危险比[HR]分别为1.59、3.62、4.44和5.52，均p < 0.001）。在最初接受单药治疗的患者中，年龄改变了HbA1c的作用：在HbA1c < 7%时，中年和老年患者的HR差异不大；当HbA1c≥7%时，随着年龄的增长，HR降低（例如，40-49岁，HbA1c≥8%:HR 8.14；年龄≥80岁，HbA1c≥8%:HR 4.44；与年龄≥80岁，HbA1c < 6.5%相比）。1年内84.3%实现HbA1c < 8%；65.1% HbA1c < 7%。结论：临床医生似乎正在应用治疗强化指南和个体化治疗，考虑患者的年龄，在大多数偶发糖尿病患者中实现血糖控制。版权所有©2014 John Wiley & Sons， Ltd。
PurposeAntihyperglycemic medication intensification practices among patients with incident diabetes are incompletely understood. We characterized the first intensification the year after oral antihyperglycemic medication initiation among incident diabetes patients.MethodsThis retrospective cohort study across 11 US health systems included adults identified with incident diabetes between 2005 and 2009 who started oral antihyperglycemic monotherapy or combination therapy within 6 months after diabetes identification. We determined intensification, defined as increased index medication dosage, addition of another oral medication, or switch to/addition of insulin 31–365 days after initial antihyperglycemic dispensing. Cox regression was used to assess intensification for patient, temporal, and system covariates, adjusting for glycosylated hemoglobin (HbA1c) as a time‐dependent variable.ResultsAmong 41 233 patients, 33.5% and 45.3% had treatment intensified within 6 and 12 months, respectively. This first intensification was most often with increased index medication dosage (78%), least often with insulin (<1%). HbA1c% was strongly associated with intensification (adjusted hazard ratios [HR] 1.59, 3.62, 4.44, and 5.52 for HbA1c 6.5% to <7%, 7% to <7.5%, 7.5 to <8%, and ≥8%, respectively, allP< 0.001, compared with HbA1c < 6.5%). In patients initially on monotherapy, age modified the HbA1c effect: at HbA1c < 7%, the HR differed little between middle‐aged and older patients; at HbA1c ≥ 7%, the HR decreased with older age (e.g., age 40–49 years and HbA1c ≥ 8%: HR 8.14; age ≥ 80 years and HbA1c ≥ 8%: HR 4.44; compared with age ≥ 80 years and HbA1c < 6.5%). Within 1 year, 84.3% achieved HbA1c < 8%; 65.1% achieved HbA1c < 7%.ConclusionsClinicians appear to be applying treatment intensification guidelines and individualizing therapy by considering patient age, achieving glycemic control among most incident diabetes patients. Copyright © 2014 John Wiley & Sons, Ltd.