低血糖和急性代谢并发症(AMC;酮症酸中毒,高渗透压,和昏迷)是具有高成本和高发病率的血糖结果;在选择二甲双胍后的初始二线治疗时,必须考虑这些结果。我们进行了一项回顾性队列研究,分析了开始使用二线糖尿病药物(磺脲类药物[SFU],噻唑烷二酮[TZDs],胰高血糖素样肽1[GLP-1]激动剂,二肽基肽酶4[DPP-4]抑制剂,基础胰岛素,或钠-葡萄糖转运蛋白2[SGLT-2]抑制剂)在2011年4月1日至2015年9月30日之间(N=43,288),并比较了低血糖和AMC的发生率。大多数患者(24,506[56.6%])被处方磺脲类药物作为二线治疗,其次是DPP-4抑制剂(7953[18.4%]),GLP-1激动剂(3854[8.9%]),基础胰岛素(2542[5.9%]),SGLT-2抑制剂(2537[5.9%),和TZDs(1896[4.4%])。在最初的二线抗糖尿病药物类别中,低血糖的基线发生率变化超过5倍。AMC的比率变化了7倍。与服用SFU的患者相比,较低的低血糖调整率与服用DPP-4抑制剂相关(降低63%;发生率比[IRR],0.37;95%CI,0.25至0.57),SGLT-2抑制剂(降低54%;内部收益率,0.46;95%CI,0.22至0.94),或TZD(降低79%;内部收益率,0.21;95%CI,0.08至0.56),但不是胰高血糖素样肽1激动剂或基础胰岛素。对于AMC,仅启动DPP-4抑制剂(降低43%的比率;IRR,0.57;95%CI,0.41至0.81)与SFU相比具有较低的调整率。与SFU相比,SGLT-2抑制剂的使用与急性代谢并发症的发生率无关。在选择二甲双胍后的二线糖尿病治疗时,仍然需要特别注意血糖结果。
Hypoglycemia and acute metabolic complications (AMCs; ketoacidosis, hyperosmolarity, and coma) are glycemic outcomes that have high cost and high morbidity; these outcomes must be taken into consideration when choosing initial second-line therapy after metformin. We conducted a retrospective cohort study analyzing national administrative data from adults with type 2 diabetes mellitus who started a second-line diabetes medication (sulfonylureas [SFUs], thiazolidinediones [TZDs], glucagon-like peptide 1 [GLP-1] agonists, dipeptidyl peptidase 4 [DPP-4] inhibitors, basal insulin, or sodium-glucose contransporter 2 [SGLT-2] inhibitors) between April 1, 2011 and September 30, 2015 (N=43,288) and compared rates of hypoglycemia and AMCs. Most patients (24,506 [56.6%]) were prescribed sulfonylurea as second-line treatment, followed by DPP-4 inhibitors (7953 [18.4%]), GLP-1 agonists (3854 [8.9%]), basal insulin (2542 [5.9%]), SGLT-2 inhibitors (2537 [5.9%), and TZDs (1896 [4.4%]). Baseline rates of hypoglycemia varied more than 5-fold across initial second-line antidiabetic medication classes, and rates of AMCs varied 7-fold. Compared with patients taking an SFU, lower adjusted rates of hypoglycemia were associated with taking a DPP-4 inhibitor (63% lower rate; incidence rate ratio [IRR], 0.37; 95% CI, 0.25 to 0.57), SGLT-2 inhibitor (54% lower; IRR, 0.46; 95% CI, 0.22 to 0.94), or TZD (79% lower; IRR, 0.21; 95% CI, 0.08 to 0.56) but not a glucagon-like peptide 1 agonist or basal insulin. For AMCs, only initiation of a DPP-4 inhibitor (43% lower rate; IRR, 0.57; 95% CI, 0.41 to 0.81) was associated with a lower adjusted rate compared with SFU. Use of SGLT-2 inhibitors was not associated with a substantially increased rate of acute metabolic complications compared with SFU. Special attention still needs to be paid to glycemic outcomes when choosing a second-line diabetes therapy following metformin.