■新诊断的2型糖尿病(T2D)患者达到HbA1c目标的延迟与发生心血管疾病(CVD)的长期风险增加有关。一种被称为遗产效应的现象。早期引入对CVD有明显益处的降糖药物是否可以减弱这种现象尚不清楚。
■使用来自大型意大利临床注册的数据,即AMD年鉴,我们确定了251,339名新诊断为T2D且基线无CVD的受试者.通过Cox回归对多个风险因素进行调整,我们检查了平均HbA1c在7.1和8%之间或>8%之间的相关性,与≤7%相比,对于早期暴露的各个时期(0-1,0-2,0-3年)和晚期(平均后续随访4.6±2.9年)CVD的发展,评估为心肌梗塞的复合物,中风,冠状动脉或外周血管重建术,和冠状动脉或外周搭桥。我们在整个队列中进行了此分析,然后将人群分为两组患者:在暴露阶段引入钠-葡萄糖转运蛋白2抑制剂(SGLT-2i)的患者和未使用这些药物治疗的患者。
■考虑到整个队列,受试者的平均HbA1c在7.1和8%之间,>8%,与平均HbA1c≤7%的患者相比,在评估的所有三个早期暴露期中,显示出发展结果的风险增加,在3年暴露期平均HbA1c>8%的患者中观察到最高风险(风险比[HR]1.33;95%置信区间[CI]1.063-1.365).在0-1和0-2年的暴露期引入SGLT-2i消除了不良血糖控制与结果之间的关联(p分别为0.006和0.003,vs.血糖控制程度相同但未使用这些药物治疗的患者)。
■在基线时新诊断为T2D且无CVD的患者中,诊断后前3年血糖控制不佳与随后的CVD风险增加相关.当SGLT-2i在头两年推出时,这种关联不再明显,这表明这些药物减弱了遗留效应的现象。因此,这些药物的早期治疗可能会促进T2D诊断后未达到适当血糖控制的患者的长期益处。
■这项工作得到了支持,在某种程度上,由意大利卫生部(RicercaCorrente)到IRCCSMultiMedica。
UNASSIGNED: A delay in reaching HbA1c targets in patients with newly-diagnosed type 2 diabetes (T2D) is associated with an increased long-term risk of developing cardiovascular diseases (CVD), a phenomenon referred to as legacy effect. Whether an early introduction of glucose-lowering drugs with proven benefit on CVD can attenuate this phenomenon is unknown.
UNASSIGNED: Using data derived from a large Italian clinical registry, i.e. the AMD Annals, we identified 251,339 subjects with newly-diagnosed T2D and without CVD at baseline. Through Cox regressions adjusted for multiple risk factors, we examined the association between having a mean HbA1c between 7.1 and 8% or >8%, compared with ≤7%, for various periods of early exposure (0-1, 0-2, 0-3 years) and the development of later (mean subsequent follow-up 4.6 ± 2.9 years) CVD, evaluated as a composite of myocardial infarction, stroke, coronary or peripheral revascularization, and coronary or peripheral bypass. We performed this analysis in the overall cohort and then splitting the population in two groups of patients: those that introduced sodium-glucose transport protein 2 inhibitors (SGLT-2i) during the exposure phase and those not treated with these drugs.
UNASSIGNED: Considering the whole cohort, subjects with both a mean HbA1c between 7.1 and 8% and >8%, compared with patients attaining a mean HbA1c ≤ 7%, showed an increased risk of developing the outcome in all the three early exposure periods assessed, with the highest risk observed in patients with mean HbA1c > 8% in the 3 years exposure period (hazard ratio [HR]1.33; 95% confidence interval [CI] 1.063-1.365). The introduction of SGLT-2i during the exposure periods of 0-1 and 0-2 years eliminated the association between poor glycemic control and the outcome (p for interaction 0.006 and 0.003, respectively, vs. patients with the same degree of glycemic control but not treated with these drugs).
UNASSIGNED: Among patients with newly diagnosed T2D and free of CVD at baseline, a poor glycemic control in the first three years after diagnosis is associated with an increased subsequent risk of CVD. This association is no longer evident when SGLT-2i are introduced in the first two years, suggesting that these drugs attenuate the phenomenon of legacy effect. An early treatment with these drugs might thus promote a long-lasting benefit in patients not attaining proper glycemic control after T2D diagnosis.
UNASSIGNED: This work was supported, in part, by the Italian Ministry of Health (Ricerca Corrente) to IRCCS MultiMedica.