背景:先前的证据对二甲双胍与贫血之间的关系产生了矛盾的发现。这项研究旨在评估北京2型糖尿病(T2D)患者使用二甲双胍是否与缺铁性贫血(IDA)风险相关。中国。
方法:总的来说,根据历史队列研究设计,纳入了60,327例新诊断的T2D患者。与这些患者有关的信息来自北京医疗索赔员工数据库。然后将这些患者分为二甲双胍和非二甲双胍组,并根据其初始抗糖尿病处方以1:1的倾向评分进行匹配。Cox比例风险模型用于计算发病率和风险比(HR)。
结果:该研究纳入了27,960名2型糖尿病患者,在每个初始降糖处方组中有13,980名患者:二甲双胍和非二甲双胍。在4.84年的中位随访期内,4832名患者发展为IDA。二甲双胍组(26.08/1000人年)的IDA发生率明显低于非二甲双胍组(43.20/1000人年)。在三组中,以二甲双胍覆盖的天数比例划分,我们发现二甲双胍治疗天数比例与IDA风险呈负相关.二甲双胍覆盖天数比例<20%的患者发生IDA的风险,20-79%,≥80%为0.43(0.38,0.48),0.37(0.34,0.42),和0.91(0.85,0.98),分别,与非二甲双胍组相比。我们还进行了亚组分析和敏感性分析:在所有亚组中,二甲双胍组的IDA发生率均低于非二甲双胍组。在年龄≥65岁,Charlson合并症指数(CCI)≥2和使用胃酸抑制剂的患者亚组中,保护作用更为显着。
结论:在中国T2DM患者中,二甲双胍治疗与IDA入院风险降低相关,这种风险对二甲双胍覆盖天数的比例反应积极。这些发现表明,二甲双胍可能对2型糖尿病患者的IDA具有多效性作用。我们的研究对糖尿病和其他增加IDA风险的疾病患者的管理具有重要的临床意义。
BACKGROUND: Previous evidence yielded contradictory findings on the relationship between metformin and anemia. This study aims to assess whether metformin use is associated with iron-deficiency anemia (IDA) risk in patients with type 2 diabetes (T2D) in Beijing,
China.
METHODS: Overall, 60,327 newly diagnosed T2D patients were included based on a historical cohort study design. The information pertaining to these patients was gathered from the Beijing Medical Claim Data for Employees Database. These patients were then categorized into the metformin and non-metformin groups and matched on a 1:1 propensity score based on their initial antidiabetic prescription. The Cox proportional hazards models were utilized to calculate the incidences and the hazard ratios (HRs).
RESULTS: The study enrolled 27,960 patients with type 2 diabetes, with 13,980 patients in each of the initial glucose-lowering prescription groups: metformin and non-metformin. During a median follow-up period of 4.84 years, 4832 patients developed IDA. The incidence of IDA was significantly lower in the metformin group (26.08/1000 person-years) than in the non-metformin group (43.20/1000 person-years). Among the three groups divided by the proportion of days covered by metformin, we found a negative correlation between the proportion of days covered by metformin and the risk of IDA. The risk of IDA in patients with a proportion of days covered by metformin of <20%, 20-79%, and ≥80% was 0.43 (0.38, 0.48), 0.37 (0.34, 0.42), and 0.91 (0.85, 0.98), respectively, compared to the non-metformin group. We also performed subgroup analyses and sensitivity analyses: the incidence of IDA in the metformin group was lower than that in the non-metformin group in all subgroups, and the protective effect was more significant in subgroups of patients aged ≥65, with Charlson comorbidity index (CCI) ≥2, and with gastric acid inhibitor use.
CONCLUSIONS: In Chinese patients with T2DM, metformin treatment was associated with a decreased risk of IDA admission, and this risk responded positively to the proportion of days covered by metformin. These findings suggest that metformin may have a pleiotropic effect on IDA in patients with type 2 diabetes. Our study has important clinical implications for the management of patients with diabetes and other conditions that increase the risk of IDA.