Impact of Race and Ethnicity on Severe Hypoglycemia Associated with Sulfonylurea Use for Type 2 Diabetes among Veterans.
Impact of Race and Ethnicity on Severe Hypoglycemia Associated with Sulfonylurea Use for Type 2 Diabetes among Veterans.
复制标题
种族和民族对退伍军人中使用磺酰脲治疗 2 型糖尿病相关的严重低血糖的影响。
DOI：
10.1007/s40615-023-01619-0
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发表时间：
2023
影响因子：
3.9
通讯作者：
Taber,DavidJ
中科院分区：
文献类型：
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作者：
Weeda,ErinR;Ward,Ralph;Gebregziabher,Mulugeta;Axon,RNeal;Taber,DavidJ
磺脲类药物与低血糖症有关。尚不清楚该安全性结局是否存在种族/民族差异。我们试图评估人种/种族对使用磺脲类药物治疗2型糖尿病（T2 D）相关严重低血糖的影响。使用退伍军人事务和医疗保险数据，确定了2004年至2006年期间最初接受二甲双胍单药治疗T2 D的退伍军人。在随访期间（2007-2016年），采集磺酰脲类药物使用情况（单独使用或通过在二甲双胍中添加磺酰脲类药物处方），并与继续单独使用二甲双胍进行比较。采用纵向竞争风险考克斯模型的风险比（HR）和95%置信区间（CI）来衡量磺脲类药物使用与重度低血糖（定义为因低血糖住院）之间的相关性。共有113，668名患有T2 D的退伍军人被纳入其中。在所有组中，接受磺脲类药物处方与继续接受二甲双胍单药相比，重度低血糖风险较高。西班牙裔退伍军人的影响最大（HR：7.59，95%CI：4.32-13.33），其次是其他种族/民族队列的退伍军人（HR：4.57，95%CI：2.50-8.36）和非西班牙裔黑人退伍军人（HR：3.67，95%CI：2.78-4.85）。非西班牙裔白色退伍军人中的影响最小（HR：3.11，95%CI：2.77-3.48）。总之，在所有分析中均观察到与磺脲类药物处方相关的重度低血糖风险较高。这种关系在西班牙裔退伍军人中最为明显，他们使用磺脲类药物发生重度低血糖的风险是继续单独使用二甲双胍的近8倍。
Sulfonylureas are associated with hypoglycemia. Whether a racial/ethnic disparity in this safety outcome exists is unknown. We sought to assess the impact of race/ethnicity on severe hypoglycemia associated with sulfonylurea use for type 2 diabetes (T2D). Using Veterans Affairs and Medicare data, Veterans initially receiving metformin monotherapy for T2D between 2004 and 2006 were identified. Sulfonylurea use (either alone or via the addition of a prescription for a sulfonylurea to metformin) was captured and compared to remaining on metformin alone during the follow-up period (2007–2016). Hazard ratios (HR) and 95% confidence intervals (CI) from longitudinal competing risk Cox models were used to measure the association between sulfonylurea use and severe hypoglycemia defined as hospitalization for hypoglycemia. A total of 113,668 Veterans with T2D were included. A higher risk of severe hypoglycemia was associated with the receipt of sulfonylurea prescriptions versus remaining on metformin alone across all groups. The effect was largest among Hispanic Veterans (HR: 7.59, 95%CI:4.32–13.33), followed by Veterans in the other race/ethnicity cohort (HR: 4.57, 95%CI:2.50–8.36) and Non-Hispanic Black Veterans (HR: 3.67, 95%CI:2.78–4.85). The effect was smallest among Non-Hispanic White Veterans (HR: 3.11, 95%CI:2.77–3.48). In conclusion, a higher risk of severe hypoglycemia associated with sulfonylurea prescriptions was observed across all analyses. The relationship was most pronounced for Hispanic Veterans, who had nearly 8 times the risk of severe hypoglycemia with sulfonylureas versus remaining on metformin alone.