JCEM:审视胰岛素在2型糖尿病中的应用价值
2013-05-30 佚名 解放军第306医
1月31日,英国研究者在《临床内分泌与代谢杂志》发表了一项回顾性队列研究。研究者关注了胰岛素在2型糖尿病治疗中的安全性,研究分析显示,胰岛素与2型糖尿病患者的糖尿病相关并发症、癌症和全因死亡危险升高相关。尽管文章作者指出,在解读结果时应考虑到不同治疗组患者基线特征存在差异,此项研究仍引发医师和患者对于胰岛素治疗糖尿病的担忧和思考。因而,有必要深入分析此项研究,并回顾和审视胰岛素在2型糖尿病治疗
1月31日,英国研究者在《临床内分泌与代谢杂志》发表了一项回顾性队列研究。研究者关注了胰岛素在2型糖尿病治疗中的安全性,研究分析显示,胰岛素与2型糖尿病患者的糖尿病相关并发症、癌症和全因死亡危险升高相关。尽管文章作者指出,在解读结果时应考虑到不同治疗组患者基线特征存在差异,此项研究仍引发医师和患者对于胰岛素治疗糖尿病的担忧和思考。因而,有必要深入分析此项研究,并回顾和审视胰岛素在2型糖尿病治疗中的应用价值。
一、回顾性队列研究再度关注胰岛素安全性
Mortality and other important diabetes-related outcomes with insulin vs other antihyperglycemic therapies in type 2 diabetes.
Abstract
CONTEXT: The safety of insulin in the treatment of type 2 diabetes mellitus (T2DM) has recently undergone scrutiny.
OBJECTIVE: The objective of the study was to characterize the risk of adverse events associated with glucose-lowering therapies in people with T2DM.
DESIGN AND SETTING: This was a retrospective cohort study using data from the UK General Practice Research Database, 2000-2010.
PATIENTS: Patients comprised 84 622 primary care patients with T2DM treated with one of five glucose-lowering regimens: metformin monotherapy, sulfonylurea monotherapy, insulin monotherapy, metformin plus sulfonylurea combination therapy, and insulin plus metformin combination therapy. There were 105 123 exposure periods.
MAIN OUTCOME MEASURES: The risk of the first major adverse cardiac event, first cancer, or mortality was measured. Secondary outcomes included these individual constituents and microvascular complications.
RESULTS: In the same model, and using metformin monotherapy as the referent, the adjusted hazard ratio (aHR) for the primary end point was significantly increased for sulfonylurea monotherapy (1.436, 95% confidence interval [CI] 1.354-1.523), insulin monotherapy (1.808, 95% CI 1.630-2.005), and insulin plus metformin (1.309, 95% CI 1.150-1.491). In glycosylated hemoglobin/morbidity subgroups, patients treated with insulin monotherapy had aHRs for the primary outcome ranging from 1.469 (95% CI 0.978-2.206) to 2.644 (95% CI 1.896-3.687). For all secondary outcomes, insulin monotherapy had increased aHRs: myocardial infarction (1.954, 95% CI 1.479-2.583), major adverse cardiac events (1.736, 95% CI 1.441-2.092), stroke (1.432, 95% CI 1.159-1.771), renal complications (3.504, 95% CI 2.718-4.518), neuropathy (2.146, 95% CI 1.832-2.514), eye complications (1.171, 95% CI 1.057-1.298), cancer (1.437, 95% CI 1.234-1.674), or all-cause mortality (2.197, 95% CI 1.983-2.434). When compared directly, aHRs were higher for insulin monotherapy vs all other regimens for the primary end point and all-cause mortality.
CONCLUSIONS: In people with T2DM, exogenous insulin therapy was associated with an increased risk of diabetes-related complications, cancer, and all-cause mortality. Differences in baseline characteristics between treatment groups should be considered when interpreting these results.
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