Factors associated with DPP4i or SGLT2i utilisation: a retrospective cohort study among people with type 2 diabetes mellitus

IF 1 Q4 PHARMACOLOGY & PHARMACY

Journal of Pharmacy Practice and Research Pub Date : 2024-12-09 DOI:10.1002/jppr.1951

Ruth Sim BPharm, Chun Wie Chong PhD, Navin Kumar Loganadan PhD, Noor Lita Adam MBBCh, Zanariah Hussein MBBS, Shaun Wen Huey Lee PhD

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引用次数: 0

Abstract

Background

Dipeptidyl peptidase-4 inhibitors (DPP4i) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) are increasingly used as glucose-lowering therapies in Malaysia.

Aim

To examine factors associated with the initiation of DPP4i or SGLT2i among people with type 2 diabetes mellitus (T2DM) in Malaysia.

Method

A retrospective cohort study was conducted from 1 January 2012–30 December 2020 in two tertiary Malaysian hospitals. Multivariate logistic regression was used to assess the factors associated with DPP4i or SGLT2i initiation. The impact of treatment initiation on glycaemic control, anthropometric and lipid levels at 6 and 12 months were also measured. Ethical approval was granted by the Malaysian National Medical Research Register (Reference no: NMRR-20-662-52570), the Monash University Human Research Ethics Committee (Reference no: 2020-24900-45575), the Ministry of Health Malaysia Medical Research and Ethics Committee, and the study conforms with the Declaration of Helsinki.

Results

This study included 1628 patients. Patients with co-existing dyslipidaemia (odds ratio [OR] 1.34, 95% confidence interval [CI] 1.04–1.73), cardiovascular disease (OR 1.43, 95% CI 1.1–1.87), and microalbuminuria (OR 2.47, 95% CI 1.42–4.3), with ≥5-year history of T2DM (years of T2DM 5–14 OR 1.67, 95% CI1.18–2.38; years of T2DM ≥15 OR 2.07, 95% CI 1.39–3.07), who had a body weight of ≥100 kg (OR 1.75, 95% CI 1.26–2.45), and baseline use of three or more glucose-lowering medicines (OR 2.92, 95% CI 1.74–4.91) had higher odds of being prescribed with SGLT2i. Patients aged ≥65 years old (OR 0.68, 95% CI 0.50–0.93), presented with a family history of diabetes (OR 0.64, 95% CI 0.47–0.89), an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m² (eGFR 60–89 mL/min/1.73 m² OR 0.60, 95% CI 0.39–0.90; eGFR ≥90 mL/min/1.73 m² OR 0.55, 95% CI 0.34–0.87), with serum creatinine ≥120 μmol/L (OR 0.31, 95% CI 0.17–0.58), and had baseline usage of sulfonylureas (OR 0.28, 95% CI 0.19–0.4) and insulin (OR 0.5, 95% CI 0.35–0.72) were more likely to receive DPP4i. Glycated haemoglobin of patients receiving these medicines reduced significantly at 6 months (DPP4i: −0.61%, p < 0.001; SGLT2i: −0.66%, p < 0.001) and 12 months (DPP4i: −0.62%, p < 0.001; SGLT2i: −0.74%, p < 0.001).

Conclusion

Treatment choice with pharmacotherapy was associated with many clinical risk factors presented by patients.

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与DPP4i或SGLT2i应用相关的因素：2型糖尿病患者的回顾性队列研究

二肽基肽酶-4抑制剂（DPP4i）和钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）在马来西亚越来越多地被用作降糖疗法。目的研究与马来西亚2型糖尿病（T2DM）患者启动DPP4i或SGLT2i相关的因素。方法回顾性队列研究于2012年1月1日至2020年12月30日在马来西亚两所三级医院进行。采用多变量logistic回归评估与DPP4i或SGLT2i起始相关的因素。还测量了治疗开始对6个月和12个月血糖控制、人体测量和脂质水平的影响。马来西亚国家医学研究登记处（参考编号：NMRR-20-662-52570）、莫纳什大学人类研究伦理委员会（参考编号：2020-24900-45575）、马来西亚卫生部医学研究和伦理委员会批准了伦理批准，该研究符合赫尔辛基宣言。结果本研究共纳入1628例患者。同时存在血脂异常血症（优势比[OR] 1.34, 95%可信区间[CI] 1.04-1.73）、心血管疾病（优势比[OR] 1.43, 95% CI 1.1-1.87）和微量白蛋白尿（优势比[OR] 2.47, 95% CI 1.42-4.3）的患者，伴有≥5年的T2DM病史(T2DM病程5-14年OR 1.67, 95% CI1.18 - 2.38；T2DM≥15年（OR 2.07, 95% CI 1.39-3.07），体重≥100 kg (OR 1.75, 95% CI 1.26-2.45)，基线使用三种或三种以上降糖药物（OR 2.92, 95% CI 1.74-4.91）的患者被开具SGLT2i的几率更高。患者年龄≥65岁（OR 0.68, 95% CI 0.50-0.93），有糖尿病家族史（OR 0.64, 95% CI 0.47-0.89），估计肾小球滤过率(eGFR)≥60 mL/min/1.73 m2 (eGFR 60 - 89 mL/min/1.73 m2 OR 0.60, 95% CI 0.39-0.90；eGFR≥90 mL/min/1.73 m2 OR 0.55, 95% CI 0.34-0.87)，血清肌酐≥120 μmol/L (OR 0.31, 95% CI 0.17-0.58)，基线使用磺脲类药物（OR 0.28, 95% CI 0.19-0.4）和胰岛素（OR 0.5, 95% CI 0.35-0.72）更容易接受DPP4i。接受这些药物治疗的患者糖化血红蛋白在6个月时显著降低(DPP4i: - 0.61%, p < 0.001；SGLT2i:−0.66%,p & lt; 0.001)和12个月(DPP4i:−0.62%,p & lt; 0.001;SGLT2i:−0.74%,p < 0.001)。结论药物治疗的选择与患者表现出的多种临床危险因素有关。

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来源期刊

Journal of Pharmacy Practice and Research Health Professions-Pharmacy

CiteScore

1.60

自引率

9.50%

发文量

期刊介绍： The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.