Introduction

Metformin is the recommended initial treatment in type 2 diabetes mellitus (T2DM), but when this does not give adequate glucose control the choice of which second-line drug to use is uncertain as none have been found to have a better overall glycaemic response. In this real-world study dipeptidyl peptidase 4 inhibitors (DPP4i), sulphonylureas (SU), thiazolidinediones (TZD) and sodium glucose co-transporter 2 inhibitors (SGLT2i) were compared for their effectiveness in lowering glycated haemoglobin (HbA1c) levels for a particular individual based on their clinical characteristics.

Methods

A retrospective analysis was undertaken of electronic health records of people with T2DM prescribed metformin alongside a DPP4i, SU, TZD or SGLT2i at second-line. Regression modelling was used to model the changes in HbA1c from baseline at month 6 and month 12 for the individual therapies, adjusting for demographic and clinical characteristics.

Results

There were 7170 people included in the study. Treatment at second-line with SUs, DPP4i, TZDs and SGLT2i resulted in similar percentages of people achieving the recommended HbA1c target of < 7.5% (58 mmol/mol) at both 6 and 12 months. For those receiving SGLT2i and SUs, the greatest improvement in HbA1c was observed in relatively younger and older people, respectively. Trends were detected between other baseline characteristics and HbA1c improvement by drug class, but they were not statistically significant. Non-adherence rates were low for all drug classes. People with a higher medication possession ratio (≥ 80%) also had greater improvements in HbA1c at 12 months.

Conclusion

This study identified patients’ phenotypic characteristics that may have the potential to influence individual treatment response. Accounting for these characteristics in clinical treatment decisions may facilitate individualised prescribing by being able to select the right drug for the right patient.

中文翻译：

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2型糖尿病患者接受二甲双胍治疗后该怎么办？为合适的患者选择合适的药物。

介绍

二甲双胍是2型糖尿病（T2DM）的推荐初始治疗方法，但是当这不能提供足够的血糖控制时，使用哪种二线药物的选择是不确定的，因为尚未发现它具有更好的总体血糖反应。在这项真实世界的研究中，比较了二肽基肽酶4抑制剂（DPP4i），磺酰脲类（SU），噻唑烷二酮（TZD）和钠葡萄糖共转运蛋白2抑制剂（SGLT2i）降低特定糖化血红蛋白（HbA1c）水平的有效性。根据他们的临床特点。

方法

回顾性分析了二线处方T2DM处方二甲双胍和DPP4i，SU，TZD或SGLT2i的患者的电子健康记录。回归模型用于对HbA1c从第6个月和第12个月的基线到基线的变化进行建模，以适应人口统计学和临床​​特征。

结果

研究中有7170人。在SU和DPP4i，TZD和SGLT2i的二线治疗中，在6个月和12个月内，达到建议的HbA1c目标<7.5％（58 mmol / mol）的人群相近。对于那些接受SGLT2i和SU的人群，分别在相对年轻和老年人中观察到HbA1c的最大改善。根据药物类别检测到其他基线特征和HbA1c改善之间的趋势，但没有统计学意义。所有药物类别的不依从率均较低。药物拥有率较高（≥80％）的人在12个月时HbA1c的改善也更大。

结论

这项研究确定了患者的表型特征，可能会影响个体治疗反应。通过能够为合适的患者选择合适的药物，在临床治疗决策中考虑这些特征可以促进个性化的处方。