Feb. 8, 2004 - 一項發表於2月8日循環期刊上的回顧性分析、觀察性試驗結果指出,Thiazolidinediones類藥物與Metformin不僅是無害的,而且實際上對糖尿病與心臟衰竭老年病患是有益的;研究人員表示,需要進一步的隨機分派試驗來證實這項發現。
  來自科羅拉多州丹佛健康醫學中心的Frederick A. Masoudi醫師與其同事表示,儘管美國食品藥物管理局反對這項作法,但Thiazolidinediones類藥物與Metformin這類的胰島素敏感化藥物,經常使用於治療有心臟衰竭的糖尿病病患;然而,這是否會造成不好的後果仍然是未知的。

Thiazolidinediones and Metform

By Laurie Barclay, MD
Medscape Medical News

Feb. 8, 2004 — Thiazolidinediones and metformin are not only not harmful, but may actually be helpful for older patients with diabetes and heart failure, according to the results of a retrospective, observational study published in the Feb. 8 issue of Circulation. The investigators suggest that randomized trials are warranted.

"Insulin-sensitizing drugs of the thiazolidinedione class and metformin are commonly prescribed to treat diabetes in patients with heart failure despite strong warnings from the Food and Drug Administration against this practice," write Frederick A. Masoudi, MD, MSPH, from Denver Health Medical Center in Colorado, and colleagues. "Whether this results in adverse outcomes is unknown."

Using a Medicare cohort derived from the National Heart Care Project (NHC), the investigators studied the relationship between prescribing thiazolidinediones and metformin and the outcomes of death and rehospitalization among 16,417 elderly diabetic patients after hospitalization for heart failure.

Crude 1-year mortality rates were lower for the 2,226 patients treated with a thiazolidinedione (30.1%) and for the 1,861 patients treated with metformin (24.7%) than for the 12,069 patients treated with neither drug (36.0%, P < .0001 for both comparisons). Multivariate analysis suggested that risk of death was significantly lower with thiazolidinedione treatment (hazard ratio [HR] 0.87, 95% confidence interval [CI], 0.80 to 0.94) or metformin treatment (HR = .87, 95% CI 0.78 to 0.97).

Treatment with sulfonylureas or insulin did not affect mortality. Although admissions for all causes did not differ with either medication class, risk of readmission for heart failure was higher with thiazolidinedione treatment (HR 1.06, 95% CI 1.00 to 1.09) and lower with metformin treatment (HR 0.92, 95% CI 0.92 to 0.99).

"This observational study suggests that thiazolidinediones and metformin are not associated with increased mortality and may improve outcomes in older patients with diabetes and heart failure," the authors write. "These findings do not support the existing recommendations against the use of insulin sensitizers in many, if not all, patients with heart failure but emphasize the importance of close monitoring of patients treated with thiazolidinediones."

Study limitations include observational design, possible differences in the treating physicians and hospitals and the clustering of patients within hospitals causing unmeasured confounding, inability to identify changes in medication regimens after hospital discharge, lack of generalizability to younger or ambulatory patients, and inability to assess other important outcomes beyond mortality and readmission.

"Further clarification of the best clinical approach to the use of insulin-sensitizing drugs, optimally with randomized clinical trials, will be important in advancing the treatment of the rapidly growing population with both diabetes and heart failure," the authors conclude.

The Centers for Medicare & Medicaid Services, sponsored this analysis. The National Institutes of Health and National Institutes of Aging supported two of the authors. Some authors report various financial arrangements with AstraZeneca, Pfizer, Takeda Pharmaceuticals, GlaxoSmithKline, Bristol-Myers Squibb, and/or Merck.

Circulation. 2005;111:xxx-xxx

Reviewed by Gary D. Vogin, MD

2017/1/12 上午 11:07:07
別老是坐著 少坐一點對糖尿病有好處
2016/12/9 上午 10:05:25
2016/9/21 下午 03:39:06

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