初发2型糖尿病患者二甲双胍和磺脲类药物治疗时长与微血管并发症之间的关联：一项汇总队列分析
The association between duration of metformin and sulfonylurea treatment and microvascular complications in patients with incident type 2 diabetes: a pooled cohort analysis.
作者信息
Bahardoust Mansour, Mehrabi Yadollah, Hadaegh Farzad, Azizi Fereidoun, Khalili Davood, Delpisheh Ali
机构信息
Department of Epidemiology, School of Public Health & Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
出版信息
J Diabetes Metab Disord. 2025 Apr 1;24(1):94. doi: 10.1007/s40200-025-01577-w. eCollection 2025 Jun.
OBJECTIVES
The effect of the duration of medication with metformin and sulfonylurea (SUs) on microvascular complications based on the duration of type 2 diabetes (DM2) is unclear. The aim of this study was to investigate the association of medication time with metformin and SUs and microvascular complications in newly diagnosed DM2 patients.
METHODS
In this prospective multi-cohort study, data from 3,904 newly diagnosed DM from three cohorts of the Tehran Lipid and Glucose Study (TLGS), the Multi-Ethnic Study of Atherosclerosis (MESA), and the Atherosclerosis Risk in Communities (ARIC) with a mean age of 59.6 ± 08 years were pooled. Metformin medication time alone, SUs alone, and a combination of both since drug initiation were defined as exposure. The incidence of microvascular complications (diabetic nephropathy or retinopathy) was defined as outcomes. The cumulative exposure to metformin, SUs, aspirin, statin, and anti-hypertensive medication was also determined using the same approach.
RESULTS
Metformin alone, SUs alone, and the combination of both reduced the hazard of microvascular complications by 8%(HR: 0.92, 95% CI: 0.89, 0.96, P: 0.001), 6%(HR: 0.94, 95% CI: 0.92, 0.97, P: 0.004), and 9%(HR: 0.91, 95% CI: 0.89, 0.94, P: 0.001) for each year of use, respectively ( < 0.05). The protective effect of metformin and SUs, individually or in combination, on microvascular complications started approximately five years after the initial treatment and continued until approximately 15 years after the initial treatment and then reached a plato.
CONCLUSION
long-term use of metformin and SUs individually and in combination was associated with a decrease in the risk of microvascular outcomes in newly diagnosed DM for up to about one decade. These findings highlight the importance of choosing an appropriate treatment regimen for new patients with type 2 diabetes. Appropriate oral therapy can minimize microvascular complications and improve overall well-being.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s40200-025-01577-w.
目的
二甲双胍和磺脲类药物（SUs）的用药时长对基于2型糖尿病（DM2）病程的微血管并发症的影响尚不清楚。本研究的目的是调查新诊断DM2患者中二甲双胍和SUs的用药时间与微血管并发症之间的关联。
方法
在这项前瞻性多队列研究中，汇总了来自德黑兰脂质和葡萄糖研究（TLGS）、多民族动脉粥样硬化研究（MESA）和社区动脉粥样硬化风险研究（ARIC）三个队列的3904例新诊断DM患者的数据，平均年龄为59.6±08岁。自开始用药以来，单独使用二甲双胍的用药时间、单独使用SUs的用药时间以及两者联合使用的时间被定义为暴露因素。微血管并发症（糖尿病肾病或视网膜病变）的发生率被定义为结局指标。还使用相同方法确定了二甲双胍、SUs、阿司匹林、他汀类药物和抗高血压药物的累积暴露量。
结果
单独使用二甲双胍、单独使用SUs以及两者联合使用，每年使用分别可使微血管并发症风险降低8%（HR：0.92，95%CI：0.89，0.96，P：0.001）、6%（HR：0.94，95%CI：0.92，0.97，P：0.004）和9%（HR：0.91，95%CI：0.89，0.94，P：0.001）（P<0.05）。二甲双胍和SUs单独或联合使用对微血管并发症的保护作用在初始治疗后约五年开始，持续到初始治疗后约15年，然后达到平稳状态。
结论
新诊断的DM患者单独或联合长期使用二甲双胍和SUs与微血管结局风险降低相关，长达约十年。这些发现凸显了为2型糖尿病新患者选择合适治疗方案的重要性。合适的口服治疗可将微血管并发症降至最低并改善整体健康状况。
补充信息
在线版本包含可在10.1007/s40200-025-01577-w获取的补充材料。
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