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Am Heart J:胰岛素治疗的2型糖尿病患者添加GLP-1RA喜忧参半

2018-03-02 吴星 环球医学

2018年2月,发表在《Am Heart J》的一项由英国科学家进行的英国大型回顾性队列研究,考察了胰岛素治疗的2型糖尿病患者加入GLP-1受体激动剂(GLP-1RA)对死亡率、心血管(CV)事件和代谢结局的影响。

2018年2月,发表在《Am Heart J》的一项由英国科学家进行的英国大型回顾性队列研究,考察了胰岛素治疗的2型糖尿病患者加入GLP-1受体激动剂(GLP-1RA)对死亡率、心血管(CV)事件和代谢结局的影响。

背景:GLP-1RA与胰岛素联用常是超重的2型糖尿病患者有效的治疗策略,但是在英国常规临床实践中,其对心血管和死亡结局的长期影响知之甚少。因此,研究者在大型英国数据库中比较了仅用胰岛素治疗vs胰岛素+GLP-1RA治疗的超重2型糖尿病患者发生严重非致死性CV事件和全因死亡的时间。

方法:使用健康促进网络数据库,对英国全科实践中的18227例胰岛素治疗的2型糖尿病患者进行了一项回顾性队列研究。研究者对倾向得分匹配的仅使用胰岛素的队列(1793例)和胰岛素+GLP-1RA队列(1793例)进行了5年死亡风险和3分全因死亡和非致命性CV结局(心梗或卒中)复合的比较,不考虑其他糖尿病治疗如何。此比较共产生了12682人-年的随访。Cox成比例风险模型用于评估结局的风险比。

结果:两组糖化血红蛋白的降低相似(12个月时,-0.42% vs -0.33%)。总体来说,仅使用胰岛素vs胰岛素+GLP-1RA的全因死亡和CV事件(严重不良心血管事件)的3分复合事件为98 vs 55(14.7 vs 9.2/1000人-年;校正风险比[aHR],0.64;95% CI,0.42~0.98;P=0.038)。相应的复合性非致命性CV事件为33 vs 28(6.0 vs 5.6/1000人-年;aHR,0.76;95% CI,0.41~1.42;P=0.393),而全因死亡事件为49 vs 13(6.9 vs 2.0/1000人-年;aHR,0.35;95% CI,0.17~0.73;P=0.005)。

结论:基于常规临床实践中的英国大型队列,将GLP-1RA加入到胰岛素治疗中与超重的2型糖尿病患者复合CV事件和全因死亡风险的降低相关,但是会出现心衰住院风险非显著性增加。

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    2018-08-24 360611848
  2. 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    2018-12-25 baoya
  3. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1622003, encodeId=975f1622003aa, content=<a href='/topic/show?id=392480e970' target=_blank style='color:#2F92EE;'>#GLP-1RA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8079, encryptionId=392480e970, topicName=GLP-1RA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=)]
    2018-03-05 大爰

    学习了谢谢分享!!

    0

  4. 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topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1383413, encodeId=933d138341353, content=<a href='/topic/show?id=196a1101f7' target=_blank style='color:#2F92EE;'>#2型糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1101, encryptionId=196a1101f7, topicName=2型糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec19483, createdName=aids213, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1422719, encodeId=c7391422e19a6, content=<a href='/topic/show?id=54fa80e701' target=_blank style='color:#2F92EE;'>#GLP-1#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8077, encryptionId=54fa80e701, topicName=GLP-1)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f8f23732777, createdName=yibei, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474446, encodeId=2cc414e4446d9, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1514647, encodeId=f0d2151464e95, content=<a href='/topic/show?id=c8d68389847' target=_blank style='color:#2F92EE;'>#胰岛素治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83898, encryptionId=c8d68389847, topicName=胰岛素治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e51610667367, createdName=zjshifan_98647309, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562863, encodeId=63841562863e2, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1622003, encodeId=975f1622003aa, content=<a href='/topic/show?id=392480e970' target=_blank style='color:#2F92EE;'>#GLP-1RA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8079, encryptionId=392480e970, topicName=GLP-1RA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=)]
    2018-03-03 zhaojie88
  5. [GetPortalCommentsPageByObjectIdResponse(id=1658664, encodeId=54f9165866403, content=<a href='/topic/show?id=4b4d80e878' target=_blank style='color:#2F92EE;'>#GLP-1R#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8078, encryptionId=4b4d80e878, topicName=GLP-1R)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fea024898996, createdName=360611848, createdTime=Fri Aug 24 20:14:00 CST 2018, time=2018-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749932, encodeId=5ca01e49932a5, content=<a href='/topic/show?id=be7c8385345' target=_blank style='color:#2F92EE;'>#胰岛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83853, encryptionId=be7c8385345, topicName=胰岛)], attachment=null, authenticateStatus=null, createdAvatar=null, 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likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8077, encryptionId=54fa80e701, topicName=GLP-1)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f8f23732777, createdName=yibei, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474446, encodeId=2cc414e4446d9, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1514647, encodeId=f0d2151464e95, content=<a href='/topic/show?id=c8d68389847' target=_blank style='color:#2F92EE;'>#胰岛素治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83898, encryptionId=c8d68389847, topicName=胰岛素治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e51610667367, createdName=zjshifan_98647309, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562863, encodeId=63841562863e2, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1622003, encodeId=975f1622003aa, content=<a href='/topic/show?id=392480e970' target=_blank style='color:#2F92EE;'>#GLP-1RA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8079, encryptionId=392480e970, topicName=GLP-1RA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1658664, encodeId=54f9165866403, content=<a href='/topic/show?id=4b4d80e878' target=_blank style='color:#2F92EE;'>#GLP-1R#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8078, encryptionId=4b4d80e878, topicName=GLP-1R)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fea024898996, createdName=360611848, createdTime=Fri Aug 24 20:14:00 CST 2018, time=2018-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749932, encodeId=5ca01e49932a5, content=<a href='/topic/show?id=be7c8385345' target=_blank style='color:#2F92EE;'>#胰岛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83853, encryptionId=be7c8385345, topicName=胰岛)], attachment=null, authenticateStatus=null, createdAvatar=null, 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likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8077, encryptionId=54fa80e701, topicName=GLP-1)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f8f23732777, createdName=yibei, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474446, encodeId=2cc414e4446d9, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1514647, encodeId=f0d2151464e95, content=<a href='/topic/show?id=c8d68389847' target=_blank style='color:#2F92EE;'>#胰岛素治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83898, encryptionId=c8d68389847, topicName=胰岛素治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e51610667367, createdName=zjshifan_98647309, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562863, encodeId=63841562863e2, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1622003, encodeId=975f1622003aa, content=<a href='/topic/show?id=392480e970' target=_blank style='color:#2F92EE;'>#GLP-1RA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8079, encryptionId=392480e970, topicName=GLP-1RA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=)]
    2018-03-03 yibei
  7. 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  8. 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  9. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1622003, encodeId=975f1622003aa, content=<a href='/topic/show?id=392480e970' target=_blank style='color:#2F92EE;'>#GLP-1RA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8079, encryptionId=392480e970, topicName=GLP-1RA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Sat Mar 03 23:14:00 CST 2018, time=2018-03-03, status=1, ipAttribution=)]
    2018-03-03 slcumt
  10. 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