利尿剂与 2 型糖尿病患者肢体重大不良事件的风险：一项观察性回顾研究。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism Pub Date : 2024-10-03 DOI:10.1016/j.diabet.2024.101582

Khadija Ba , Laurence Salle , Laudy Serhal , Mamadou Adama Sow , Julien Magne , Philippe Lacroix , Lucie Chastaingt , Victor Aboyans

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引用次数: 0

摘要

目的：在 2 型糖尿病（T2DM）患者中，钠-葡萄糖共转运体 2 抑制剂被怀疑会增加截肢风险。"传统 "利尿剂可能会增加肢体主要不良事件（MALEs），但证据不足。我们研究了常见利尿剂（即噻嗪类、襻利尿剂和保钾利尿剂）与 T2DM 患者肢体重大不良事件/截肢之间的关系：对转诊至本中心进行心血管检查的无心血管病史的连续 T2DM 患者进行回顾性研究。我们收集了MALEs的随访数据。我们使用 Cox 模型评估了利尿剂与 MALEs 或单独截肢之间的关联。我们还进行了倾向评分与利尿剂治疗逆概率加权（IPTW）分析：我们研究了 1309 名患者（59.5±10.7 岁，51% 为女性），他们的糖尿病病程为 9.1±8.5 年，其中 402 人（30%）服用了利尿剂。在 3.8±1.64 年的随访期间，121 例（9.1%）患者出现男性糖尿病，其中 19 例（1.4%）截肢。111名患者死亡，不同组间的死亡比例有显著差异：使用利尿剂的患者n=49，44.1%；未使用利尿剂的患者n=62，55.9%，P=0.001。在多变量分析中，利尿剂与男性死亡率相关（aHR[95%CI] 1.96[1.32;2.91] P = 0.001），即使根据倾向评分（aHR 1.66[1.08;2.56] P = 0.02）和IPTW分析（aHR 1.76[1.67;1.84] P < 0.0001）进行调整后也是如此。基线踝肱指数异常（aHR 2.29[1.32;3.96]，P = 0.003）的风险尤其增加。从利尿剂类别分别来看，襻利尿剂（aHR 2.56[1.16;5.64] P = 0.020）、噻嗪类（aHR 2.21[1.37;3.57] P = 0.001）或排钾利尿剂（aHR 2.56[1.16;5.64] P = 0.020）的调整后风险增加：结论：利尿剂治疗加权可能与男性乳腺癌风险增加有关。我们发现了几种肢体事件风险增加的标志物，应谨慎使用利尿剂。

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Diuretics and risk of major adverse limb events in patients with type-2 diabetes: An observational retrospective study

Aim

In patients with type-2 diabetes mellitus (T2DM), sodium-glucose co-transporter 2 inhibitors are suspected to increase the risk of amputation. “Traditional” diuretics may increase major adverse limb events (MALEs), but the evidence is weak. We studied the association between common diuretics (i.e. thiazides, loop- and potassium-sparing diuretics) and MALEs/amputations in patients with T2DM.

Methods

Consecutive T2DM patients without cardiovascular history referred to our center for cardiovascular check-ups were retrospectively studied. Follow-up data on MALEs were collected. We used Cox models to assess the association between diuretics and MALEs, or amputation alone. A propensity score with inverse probability of diuretic treatment weighting (IPTW) analysis was performed.

Results

We studied 1309 patients, (59.5 ± 10.7 years, 51 % females) with diabetes duration of 9.1 ± 8.5 years, among whom 402 (30 %) were taking diuretics. During a follow-up of 3.8 ± 1.64 years, 121 (9.1 %) had MALEs, including 19 (1.4 %) amputations. Death occurred in 111 patients and the proportion of death was significantly different between groups: patients with diuretics n = 49, 44.1% vs patients without diuretics n = 62, 55.9 %, P = 0.001. Diuretics, in multivariable analysis, were associated with MALEs (aHR[95 %CI] 1.96[1.32;2.91] P = 0.001), even after adjustment on propensity score (aHR 1.66[1.08;2.56] P = 0.02) and IPTW analysis (aHR 1.76[1.67;1.84] P < 0.0001). This risk was particularly increased in case of an abnormal ankle-brachial index (aHR 2.29[1.32;3.96], P = 0.003) at baseline. Looking at diuretic classes separately, the adjusted risk was increased with loop diuretics (aHR 2.56[1.16;5.64] P = 0.020), thiazides (aHR 2.21[1.37;3.57] P = 0.001) or potassium sparing diuretics (aHR 2.56[1.16;5.64] P = 0.020).

Conclusion

Diuretic treatment weighting may be associated with increased risk of MALEs. We identified several markers of increased risk of limb events where the use of diuretics should be considered with caution.

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来源期刊

Diabetes & metabolism 医学-内分泌学与代谢

CiteScore

12.00

自引率

4.20%

发文量

审稿时长

13 days

期刊介绍： A high quality scientific journal with an international readership Official publication of the SFD, Diabetes & Metabolism, publishes high-quality papers by leading teams, forming a close link between hospital and research units. Diabetes & Metabolism is published in English language and is indexed in all major databases with its impact factor constantly progressing. Diabetes & Metabolism contains original articles, short reports and comprehensive reviews.