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首页 » 糖尿病治疗专题 » ADA:二甲双胍初始治疗更有利于降低老年糖尿病患者心血管风险

ADA:二甲双胍初始治疗更有利于降低老年糖尿病患者心血管风险

来源:elseviermed 2011-07-01 11:12

6月25日美国糖尿病学会(ADA)科学年会上公布的一项回顾性研究显示,将磺脲类药物作为初始治疗的老年糖尿病患者2年内发生心血管疾病(CVD)的风险比初始采用二甲双胍治疗者增加33%。并且磺脲类药物治疗者的CVD发生较早。

在该研究中,Ying Qui博士等人回顾了2003~2007年间通用电气医疗集团中心电子医疗记录数据库中接受磺脲类或二甲双胍作为初始糖尿病治疗、持续治疗至少90 d、处方前一年无心血管事件记录的患者资料,共涉及8,656例年龄365岁的老年人,平均年龄为49岁,其中48%为男性,每个治疗组中均有4,328例患者纳入分析。

通过倾向性分析校正可能影响处方选择的因素后,研究者发现,在其后2年中磺脲类组和二甲双胍组发生CVD事件的几率分别为14.8%和11.6%(风险率为1.33;P<0.001)。具体而言,磺脲类组发生缺血性心脏病(7.1% vs. 5.3%)和心力衰竭(3.4% vs. 1.9%)的发生率显著高于二甲双胍组。两组心肌梗死、卒中、短暂性缺血发作和外周动脉疾病的发生率无显著差异。对包含6,096例患者的队列随访3年,磺脲类组CVD事件风险仍较高,风险率为1.20。磺脲类组至首次发生CVD事件的时间显著短于二甲双胍组,2年时的风险率为1.22,3年时为1.17。此外,男性和高龄也与CVD事件风险增高相关。

研究者总结认为,与磺脲类药物相比,二甲双胍作为老年糖尿病患者的初始用药可降低CVD事件风险。(生物谷Bioon.com)

生物谷推荐原文出处:

American Diabetes Association    doi: 10.2337/dc09-1128

Health Care and Productivity Costs Associated With Diabetic Patients With Macrovascular Comorbid Conditions

Alex Z. Fu, PHD1, Ying Qiu, PHD2, Larry Radican, PHD2 and Brian J. Wells, MD, MS

OBJECTIVE To examine and quantify from the societal perspective the impact of macrovascular comorbid conditions (MVCCs) on health care and productivity costs in diabetic patients in the U.S.

RESEARCH DESIGN AND METHODS With use of the pooled Medical Expenditure Panel Survey (MEPS) 2004 and 2006 data, a nationally representative adult sample (aged ≥18 years) was included in the study. Health care cost was measured by the annual health care expenditure. Productivity cost was calculated from the lost productivity from missed work days and additional bed days due to illness/injury based on the 2006 average national hourly wage. Both 2004 and 2006 cost data were adjusted to 2006 dollars. Given the heavily right-skewed distribution of the cost data, the generalized linear model with log-link function and γ variance was used to identify the relationship between MVCCs and costs after controlling for age, sex, race, ethnicity, education, income, employment status, smoking status, health insurance, diabetes severity, and comorbidities. Negative binomial models were applied to analyze the outcomes of missed work days and bed days. All statistics were adjusted using the proper sampling weight from MEPS.

RESULTS Compared with diabetic patients without MVCCs (n = 3,320), those with MVCCs (n = 913) had statistically significant higher annual health care costs (5,120 USD, P < 0.001), more missed work days (13.03 days, P < 0.001), and more bed days (7.60 days, P = 0.025) per patient after controlling for differences in sociodemographics, smoking, diabetes severity, and comorbidities. The marginal lost productivity cost was 2,388 USD annually per patient.

CONCLUSIONS From the U.S. societal perspective, MVCCs in diabetic patients are associated with increased health care and lost productivity costs.

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