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Lancet Diab & Endo:甘精胰岛素和ω-3脂肪酸对认知的影响(ORIGIN亚组研究)

2014-06-06 CMT 中国医学论坛报糖尿病手机报

ORIGIN亚组研究随访6年的结果显示,胰岛素和ω-3脂肪酸治疗对认知下降速度和认知障碍发生率的影响为中性(neutral effect)。文章6月2日在线发表于《柳叶刀·糖尿病与内分泌学》(Lancet Diabetes Endocrinol)杂志。背景:糖尿病和非糖尿病血糖异常是加速认知下降的风险因素。在初始甘精胰岛素干预导致治疗结果下降研究(ORIGIN)的预设亚研究中,我们评估了使

ORIGIN亚组研究随访6年的结果显示,胰岛素和ω-3脂肪酸治疗对认知下降速度和认知障碍发生率的影响为中性(neutral effect)。文章6月2日在线发表于《柳叶刀·糖尿病与内分泌学》(Lancet Diabetes Endocrinol)杂志。原研究见:NEJM:6年临床试验显示甘精胰岛素不会增加癌症风险(ORIGIN研究) 

背景:糖尿病和非糖尿病血糖异常是加速认知下降的风险因素。在初始甘精胰岛素干预导致治疗结果下降研究(ORIGIN)的预设亚研究中,我们评估了使用甘精胰岛素降糖或给予ω-3脂肪酸是否能减缓或影响该人群认知损伤的进展。

方法:ORIGIN研究纳入年龄大于50岁,血糖异常,正在或未使用一种口服降糖药物,具有其它心血管事件风险因素,HbA1C低于9%,且未使用胰岛素的患者。参与者从40个国家的573个中心招募。采用因子设计将参与者随机分入滴定基础甘精胰岛素直至空腹血糖浓度为5·3mmol/L或更低,或标准治疗,以及ω-3脂肪酸(1g)或安慰剂组。治疗地点对结果调整人员及数据分析人员设盲。用细微精神状态检查(MMS)及数据符号转换(DSS)评估认知功能。测定甘精胰岛素或ω-3脂肪酸对认知功能随时间的作用,测试分数每年变化,可能的认知功能受损的进展。所有分析限于基线及至少一次随访接受了认知测定的参与者。ORIGIN研究注册于ClinicalTrials.gov,NCT00069784。

结果:2003年9月1日至2005年12月15日期间,参与者被随机分配。ORIGIN研究中11685及3392名参与者分别接受了MMSE和DSS评估(平均年龄63.4岁[SD 7.7]),中线随访时间为6.2年(IQR5.8-6.7)。甘精胰岛素和标准治疗组的认知测试分数变化的比率无差异(MMSE 0·0046,95% CI 0·0132 至0·0224,p=0·39;DSS 0·0362,0·2180 t至0·1455,p=0·34),ω-3脂肪酸和安慰剂组该比例也无差异(MMSE 0·0013,95% CI 0·0165 至 0·0191,p=0·21;DSS 0·0605,0·2422 至0·1212,p=0·72)。同样的,甘精胰岛素和标准治疗组的可能的认知受损发生率无差异(p=0·065),且ω-3脂肪酸和安慰剂组也无差异(p=0·070)。在亚组分析中,相比标准治疗,甘精胰岛素似乎能够降低血糖异常但无糖尿病证据的参与者的MMSE下降幅度(Pinteraction=0.024)。

解释:在这个相对年轻的血糖异常患者队列中,胰岛素降糖及给予ω-3脂肪酸持续至少6年,对认知下降的比率及认知受损发生率的作用为中性。以后的研究应当评估这些干预在年龄更大的队列中的作用,或其它糖代谢干预对认知下降的作用。

原始出处:


Tali Cukierman-Yaffe, Jackie Bosch, Rafael Diaz, Leanne Dyal, Nicolae Hancu, Pers Hildebrandt, Fernando Lanas, Basil S Lewis, Michel Marre, Jean-Francois Yale,Salim Yusuf, Hertzel C Gerstein, for the ORIGIN Investigators.Effects of basal insulin glargine and omega-3 fatty acid on cognitive decline and probable cognitive impairment in people with dysglycaemia: a substudy of the ORIGIN trial.The Lancet Diabetes & Endocrinology, Early Online Publication, 2 June 2014 doi:10.1016/S2213-8587(14)70062-2

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    2014-10-22 howi
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    2014-10-26 baoya
  4. [GetPortalCommentsPageByObjectIdResponse(id=1778740, encodeId=32e81e78740e3, content=<a href='/topic/show?id=2216130401' target=_blank style='color:#2F92EE;'>#3脂肪酸#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1304, encryptionId=2216130401, topicName=3脂肪酸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Wed Jan 14 07:38:00 CST 2015, time=2015-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1827809, encodeId=4a64182e80962, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Wed Oct 22 18:38:00 CST 2014, time=2014-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749479, encodeId=a42d1e49479a1, content=<a href='/topic/show?id=be7c8385345' target=_blank style='color:#2F92EE;'>#胰岛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83853, encryptionId=be7c8385345, topicName=胰岛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a7a536274692, createdName=baoya, createdTime=Sun Oct 26 01:38:00 CST 2014, time=2014-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1636886, encodeId=a8f41636886df, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Sat Apr 04 01:38:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1779116, encodeId=7a471e791166b, content=<a href='/topic/show?id=2216130401' target=_blank style='color:#2F92EE;'>#3脂肪酸#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1304, encryptionId=2216130401, topicName=3脂肪酸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Sun Nov 23 22:38:00 CST 2014, time=2014-11-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1329859, encodeId=046d1329859da, content=<a href='/topic/show?id=8f3a19290dd' target=_blank style='color:#2F92EE;'>#ω-3脂肪酸#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19290, encryptionId=8f3a19290dd, topicName=ω-3脂肪酸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=232a2500033, createdName=1249859em38(暂无昵称), createdTime=Sun Jun 08 01:38:00 CST 2014, time=2014-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393156, encodeId=7f6c13931564a, content=<a href='/topic/show?id=eb2b6882506' target=_blank style='color:#2F92EE;'>#甘精胰岛素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68825, encryptionId=eb2b6882506, topicName=甘精胰岛素)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIUEDhSibBFt8TicgFCCSBtW10SxVJicDpibTCucns8L1YaiaKpibWOkv8hYpJ0LeTVUH1Ab4sfica9bxiccA/132, createdBy=dd282500126, createdName=ms3830150583600765, createdTime=Sun Jun 08 01:38:00 CST 2014, time=2014-06-08, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1778740, encodeId=32e81e78740e3, content=<a href='/topic/show?id=2216130401' target=_blank style='color:#2F92EE;'>#3脂肪酸#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1304, encryptionId=2216130401, topicName=3脂肪酸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Wed Jan 14 07:38:00 CST 2015, time=2015-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1827809, encodeId=4a64182e80962, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Wed Oct 22 18:38:00 CST 2014, time=2014-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749479, encodeId=a42d1e49479a1, content=<a href='/topic/show?id=be7c8385345' target=_blank style='color:#2F92EE;'>#胰岛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83853, encryptionId=be7c8385345, topicName=胰岛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a7a536274692, createdName=baoya, createdTime=Sun Oct 26 01:38:00 CST 2014, time=2014-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1636886, encodeId=a8f41636886df, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Sat Apr 04 01:38:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1779116, encodeId=7a471e791166b, content=<a href='/topic/show?id=2216130401' target=_blank style='color:#2F92EE;'>#3脂肪酸#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1304, encryptionId=2216130401, topicName=3脂肪酸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Sun Nov 23 22:38:00 CST 2014, time=2014-11-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1329859, encodeId=046d1329859da, content=<a href='/topic/show?id=8f3a19290dd' target=_blank style='color:#2F92EE;'>#ω-3脂肪酸#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19290, encryptionId=8f3a19290dd, topicName=ω-3脂肪酸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=232a2500033, createdName=1249859em38(暂无昵称), createdTime=Sun Jun 08 01:38:00 CST 2014, time=2014-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393156, encodeId=7f6c13931564a, content=<a href='/topic/show?id=eb2b6882506' target=_blank style='color:#2F92EE;'>#甘精胰岛素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68825, encryptionId=eb2b6882506, topicName=甘精胰岛素)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIUEDhSibBFt8TicgFCCSBtW10SxVJicDpibTCucns8L1YaiaKpibWOkv8hYpJ0LeTVUH1Ab4sfica9bxiccA/132, createdBy=dd282500126, createdName=ms3830150583600765, createdTime=Sun Jun 08 01:38:00 CST 2014, time=2014-06-08, status=1, ipAttribution=)]
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