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Anti-Diabetic Drugs and Heart Failure Risk in Patients with Type 2 Diabetes in the U.K. Primary Care Setting. Diabetes Care

机译：英国基层医疗机构中2型糖尿病患者的抗糖尿病药物和心力衰竭风险。糖尿病护理

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OBJECTIVE—To assess the effects of antidiabetic drugs on the risk of heart failure in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS—We conducted a retrospective cohort study with a newly diagnosed diabetes cohort of 25,690 patients registered in the U.K. General Practice Research Database, 1988–1999. We categorized person-time drug exposures to monotherapies in insulin, sulfonylureas (SUs), metformins, and other oral hypoglycemic agents (i.e., acarbose, guar gum) and combination therapy including insulin, combination therapy without insulin, and triple combination therapy with or without insulin. A drug-free time interval served as a reference category. Cox interval-wise (piece-wise) regression analyses were used. The main outcome was incident heart failure.RESULTS—Among 43,390 drug exposure intervals for 25,690 patients who had a mean follow-up period of 2.5 years, 1,409 patients developed heart failure. Heart failure occurred most frequently in SU monotherapy exposure. After adjusting for duration of diabetes, the timing and order of treatments received, and known risk factors for heart failure, we found no differential effects among type-specific therapies. Patients with any drug use within the first year after diabetes diagnosis had a 4.75-fold higher risk (hazard ratio) for heart failure than those with drug-free status but had no increased risk during subsequent years.CONCLUSIONS—In conclusion, the use of any pharmacological therapy for type 2 diabetes appears to be associated with an increased risk of heart failure. This risk does not persist beyond the first year after diagnosis of diabetes and does not appear to differ among the types of drug therapy examined. This observation suggests that the severity of diabetes or the preclinical duration of diabetes and the need for drug therapy, and not the therapy itself, is an explanation for heart failure in patients with type 2 diabetes.
机译：目的—评估抗糖尿病药物对2型糖尿病患者心力衰竭风险的影响。研究设计和方法—我们对一项在英国全科医学研究数据库中注册的25,690名新诊断糖尿病人群进行了回顾性队列研究。 ，1988–1999年。我们将个人时间药物暴露与胰岛素，磺酰脲类（SUs），二甲双胍和其他口服降糖药（即阿卡波糖，瓜尔胶）的单一疗法以及包括胰岛素的联合疗法，不使用胰岛素的联合疗法以及有或无三联疗法的分类胰岛素。无毒品时间间隔用作参考类别。使用Cox区间（逐段）回归分析。结果是发生心力衰竭。结果-在25,690名平均随访时间为2.5年的患者中，有4,390,390人接受药物治疗，其中1,409名患者发生了心力衰竭。 SU单一疗法暴露最常发生心力衰竭。在调整糖尿病持续时间，接受治疗的时间和顺序以及已知的心衰危险因素后，我们发现在特定类型疗法之间没有差异作用。糖尿病诊断后第一年内使用任何药物的患者，其心力衰竭的风险（危险比）比无药物状态的患者高4.75倍，但在随后的几年中没有增加的风险。任何用于2型糖尿病的药物治疗似乎都增加了心力衰竭的风险。在糖尿病诊断后的第一年之后，这种风险不会持续存在，并且在所检查的药物治疗类型之间似乎没有差异。这一发现表明，糖尿病的严重程度或糖尿病的临床前病程以及是否需要药物治疗而非治疗本身，是2型糖尿病患者心力衰竭的一种解释。

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