제2형 당뇨병 환자에서 Metformin/Dipeptidyl Peptidase-4 저해제 병용요법과 Metformin/Sulfonylurea 병용요법간의 효과에 대한 비교 연구 (Comparative Effectiveness between Dipeptidylpeptidase-4 Inhibitors and Sulfonylureas in Combination with Metformin in Type 2 Diabetes Mellitus Patients)

서지정보

· 발행기관 : 한국임상약학회
· 수록지 정보 : 한국임상약학회지 / 25권 / 2호 / 74 ~ 79페이지
· 저자명 : 박지혜, 박선이, 김재연, 김주희, 곽혜선

초록

Objective: Treatment with sulfonylureas in combination with metformin improves glycemic control in type 2 diabetes mellitus (T2DM), but is associated with hypoglycemia and weight gain. This retrospective study aims to compare the effectiveness of dipeptidylpeptidase-4 (DPP-4) inhibitors and sulfonylureas as an add-on therapy to metformin in patients with T2DM. Methods: Data from medical records of 355 T2DM patients received therapy either DPP-4 inhibitors (DPP-4 inhibitor group) or sulfonylurea (SU group) in combination with metformin from 1 March 2009 to 30 September 2011 were retrospectively reviewed. Of total 355 patients, 231 patients were in DPP-4 inhibitor group and 124 patients were in SU group. Baseline Hemoglobin A1c (HbA1c) level in SU group was higher than DPP-4 inhibitor group with a statistically significant difference (8.6% vs. 7.8%). Comparative analysis between DPP-4 inhibitor group and SU group was performed for HbA1c values, amounts of HbA1c changes, and rates of HbA1c changes from baseline at 6-month intervals and incidence rates of major cardiocerebral events. Results: SU group showed larger HbA1c changes in both amounts and rates compared to DPP-4 inhibitor group, although statistical significance was not found in all study periods. Proportions of patients with stable HbA1c <6.5% or 7% were significantly higher in DPP-4 inhibitor group than SU group (<6.5%: 30.4% vs. 13.4%, <7%: 72.3% vs. 41.2%). Time to achieve stable HbA1c <6.5% was not significantly different, but time to achieve stable HbA1c <7% was shorter in DPP4 inhibitor group than SU group with a significant difference. The incidence rate of cardiocerebral events in group of patients with or without previous events was 1.7%, not significantly lower than that in DPP-4 inhibitor group (4.0%). For newly encountered cardiocerebral events during the treatment, incidence rates of two groups did not differ significantly. Conclusion: DPP-4 inhibitors were as effective as sulfonylureas in achieving the HbA1c goal of less than 6.5% or 7% and cardiocerebral event rates did not differ between the two drugs.

영어초록

Objective: Treatment with sulfonylureas in combination with metformin improves glycemic control in type 2 diabetes mellitus (T2DM), but is associated with hypoglycemia and weight gain. This retrospective study aims to compare the effectiveness of dipeptidylpeptidase-4 (DPP-4) inhibitors and sulfonylureas as an add-on therapy to metformin in patients with T2DM. Methods: Data from medical records of 355 T2DM patients received therapy either DPP-4 inhibitors (DPP-4 inhibitor group) or sulfonylurea (SU group) in combination with metformin from 1 March 2009 to 30 September 2011 were retrospectively reviewed. Of total 355 patients, 231 patients were in DPP-4 inhibitor group and 124 patients were in SU group. Baseline Hemoglobin A1c (HbA1c) level in SU group was higher than DPP-4 inhibitor group with a statistically significant difference (8.6% vs. 7.8%). Comparative analysis between DPP-4 inhibitor group and SU group was performed for HbA1c values, amounts of HbA1c changes, and rates of HbA1c changes from baseline at 6-month intervals and incidence rates of major cardiocerebral events. Results: SU group showed larger HbA1c changes in both amounts and rates compared to DPP-4 inhibitor group, although statistical significance was not found in all study periods. Proportions of patients with stable HbA1c <6.5% or 7% were significantly higher in DPP-4 inhibitor group than SU group (<6.5%: 30.4% vs. 13.4%, <7%: 72.3% vs. 41.2%). Time to achieve stable HbA1c <6.5% was not significantly different, but time to achieve stable HbA1c <7% was shorter in DPP4 inhibitor group than SU group with a significant difference. The incidence rate of cardiocerebral events in group of patients with or without previous events was 1.7%, not significantly lower than that in DPP-4 inhibitor group (4.0%). For newly encountered cardiocerebral events during the treatment, incidence rates of two groups did not differ significantly. Conclusion: DPP-4 inhibitors were as effective as sulfonylureas in achieving the HbA1c goal of less than 6.5% or 7% and cardiocerebral event rates did not differ between the two drugs.

참고자료

· 없음