Effects of second-line antihyperglycemic drugs on the risk of chronic kidney disease: applying a target trial approach to a hospital-based cohort of Thai patients with type 2 diabetes.
Effects of second-line antihyperglycemic drugs on the risk of chronic kidney disease: applying a target trial approach to a hospital-based cohort of Thai patients with type 2 diabetes.
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DOI：
10.1186/s12933-022-01641-2
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发表时间：
2022-11-17
影响因子：
9.3
通讯作者：
中科院分区：
文献类型：
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二线治疗对2型糖尿病的肾脏保护作用已通过临床试验进行了评估，但其在常规临床实践中的普遍性仍不确定。我们的目的是评估这些治疗的有效性，当添加到二甲双胍，对慢性肾脏疾病（CKD）的风险。从2010年到2019年，在Ramathibodi医院回顾性地收集了一个真实世界的、以医院为基础的2型糖尿病队列。纳入了接受磺脲类（SU）、噻唑烷二酮类（TZD）、二肽基肽酶-4抑制剂（DPP 4 i）或钠-葡萄糖协同转运蛋白-2抑制剂（SGLT 2 i）作为二线降糖治疗的患者。使用具有逆概率加权和回归调整的治疗效应模型根据治疗估计CKD风险。在24，777例2型糖尿病患者中，有4，132例（16.7%）发现了CKD。接受SGLT 2 i、DPP 4 i、TZD和SU治疗的患者的CKD发生率（95% CI）分别为4.1%（2.2%，6.9%）、13.5%（12.5%，14.6%）、14.8%（13.5%，16.1%）和18.0%（17.4%，18.5%）。平均治疗效果（即，SGLT 2 i、DPP 4 i和TZD与SU相比的CKD风险差异为-0.142（− 0.167，− 0.116），− 0.046（− 0.059，− 0.034）和− 0.004（− 0.023，0.014），表明与SU组相比，SGLT 2 i和DPP 4 i组的CKD风险分别显著降低14.2%和4.6%。此外，与TZD和DPP 4 i相比，SGLT 2 i分别使CKD风险显著降低13.7%（10.6%，16.8%）和9.5%（6.8%，12.2%）。我们的研究发现，在真实世界临床数据中，接受SGLT 2 i治疗的泰国2型糖尿病患者与接受SU、TZD和DPP 4 i治疗的患者相比，CKD风险分别降低14.2%、13.7%和9.5%。先前在其他人群中报告的SGLT 2 i肾脏保护作用的证据与我们在该东南亚队列中的观察结果一致。在线版本包含补充材料，可通过10.1186/s12933-022-01641-2获得。
The reno-protective effect of second-line treatments in type 2 diabetes has been assessed by clinical trials but generalizability to routine clinical practice is still uncertain. We aimed to assess the effectiveness of these treatments, when added to metformin, on the risk of chronic kidney disease (CKD). A real-world, hospital-based, type 2 diabetes cohort was retrospectively assembled at Ramathibodi Hospital from 2010 to 2019. Patients who received sulfonylureas (SU), thiazolidinediones (TZD), dipeptidyl peptidase-4 inhibitors (DPP4i), or sodium-glucose cotransporter-2 inhibitors (SGLT2i), as second-line antihyperglycemic treatment were included. Treatment effect models with inverse probability weighting and regression adjustment were used to estimate CKD risk according to treatment. CKD was identified in 4,132 of the 24,777 patients with type 2 diabetes (16.7%). The CKD incidence (95% CI) was 4.1% (2.2%, 6.9%), 13.5% (12.5%, 14.6%), 14.8% (13.5%, 16.1%), and 18.0% (17.4%, 18.5%) for patients receiving SGLT2i, DPP4i, TZD, and SU treatment, respectively. The average treatment effects (i.e., the difference in CKD risk) for SGLT2i, DPP4i, and TZD compared to SU were − 0.142 (− 0.167, − 0.116), − 0.046 (− 0.059, − 0.034), and − 0.004 (− 0.023, 0.014), respectively, indicating a significant reduction in CKD risk of 14.2% and 4.6% in the SGLT2i and DPP4i groups, respectively, compared to the SU group. Furthermore, SGLT2i significantly reduced CKD risk by 13.7% (10.6%, 16.8%) and 9.5% (6.8%, 12.2%) when compared to TZD and DPP4i, respectively. Our study identified 14.2%, 13.7%, and 9.5% reduced CKD risk in Thai patients with type 2 diabetes who were treated with SGLT2i compared to those treated with SU, TZD, and DPP4i, respectively, in real-world clinical data. Previous evidence of a reno-protective effect of SGLT2i reported in other populations is consistent with our observations in this Southeast Asian cohort. The online version contains supplementary material available at 10.1186/s12933-022-01641-2.
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影响因子：
8.2
作者：
Lin, Donna Shu-Han;Lee, Jen-Kuang;Chen, Wen-Jone
通讯作者：
Chen, Wen-Jone
影响因子：
9.3
作者：
Yamada T;Wakabayashi M;Bhalla A;Chopra N;Miyashita H;Mikami T;Ueyama H;Fujisaki T;Saigusa Y;Yamaji T;Azushima K;Urate S;Suzuki T;Abe E;Wakui H;Tamura K
通讯作者：
Tamura K
影响因子：
16.2
作者：
通讯作者：
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DOI：
10.1111/dom.13301
发表时间：
2018-08
期刊：
Diabetes, obesity & metabolism
影响因子：
--
作者：
Dekkers CCJ;Petrykiv S;Laverman GD;Cherney DZ;Gansevoort RT;Heerspink HJL
通讯作者：
Heerspink HJL
影响因子：
8.2
作者：
Heerspink, Hiddo J. L.;Perco, Paul;Mayer, Gert
通讯作者：
Mayer, Gert