二甲双胍与磺脲类药物对2型糖尿病女性超长寿命的比较效果:目标试验模拟

Aladdin H Shadyab, Mark A Espeland, Andrew O Odegaard, JoAnn E Manson, Bernhard Haring, Karen C Johnson, Zhao Chen, Bowei Zhang, Andrea Z LaCroix
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摘要

背景:二甲双胍与死亡率的关系一直很复杂,没有先前的研究确定二甲双胍起始是否与超长寿命(定义为存活到90岁及以上)有关。方法:我们在妇女健康倡议队列中使用目标试验模拟框架进行了一项新用户、主动比较者队列研究,以确定二甲双胍与磺脲类药物起始是否与超长寿命(存活至90岁)相关。我们确定了≥60岁的2型糖尿病患者,在治疗开始前没有降糖药或胰岛素史,以进行意向治疗分析。我们在人口统计学特征、生活方式行为、糖尿病病程、合并症(高血压、心血管疾病、慢性阻塞性肺疾病和癌症)、体重指数和伴随用药方面使用1:1的倾向评分匹配,以平衡治疗组对关键混杂因素的影响。结果在438名倾向评分匹配的2型糖尿病女性中,开始二甲双胍单药治疗的90岁前死亡发生率为3.7 (95% CI 3.1-4.4),而磺脲类单药治疗的死亡率为5.0 (95% CI 4.2-5.8)。开始二甲双胍单药治疗与开始磺脲单药治疗相比,90岁前校正死亡风险降低30% (HR, 0.70;95% ci, 0.56-0.88)。在第一个二甲双胍和超长寿命的目标试验模拟中,我们发现在2型糖尿病女性中,与磺脲类药物相比,二甲双胍起始治疗可延长超长寿命。由于该比较没有在RCT中与安慰剂进行比较,并且考虑到观察性设计可能存在残留混淆,因此无法推断因果关系。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparative Effectiveness of Metformin vs Sulfonylureas on Exceptional Longevity in Women with Type 2 Diabetes: Target Trial Emulation
Background The association of metformin with mortality has been mixed, and no prior study has determined whether metformin initiation is associated with exceptional longevity, defined as survival to ages 90 and older. Methods We performed a new-user, active comparator cohort study using the target trial emulation framework among the Women’s Health Initiative cohort to determine whether metformin versus sulfonylurea initiation was associated with exceptional longevity (survival to age 90). We identified participants ≥60 years with incident type 2 diabetes and no history of hypoglycemic agents or insulin prior to treatment initiation to perform intention-to-treat analyses. We used 1:1 propensity score matching on demographic characteristics, lifestyle behaviors, diabetes duration, comorbidities (hypertension, cardiovascular disease, chronic obstructive pulmonary disease, and cancer), body mass index, and concomitant medications to balance treatment groups on key confounders. Results Among 438 propensity score-matched women with type 2 diabetes, the incidence rate of death before age 90 per 100 person-years in women initiating metformin monotherapy was 3.7 (95% CI 3.1-4.4) compared with 5.0 (95% CI 4.2-5.8) for sulfonylurea monotherapy. The adjusted risk of death before age 90 was 30% lower for initiation of metformin monotherapy versus sulfonylurea monotherapy (HR, 0.70; 95% CI, 0.56-0.88). Conclusions In this first target trial emulation of metformin and exceptional longevity, we found that metformin initiation increased exceptional longevity compared with sulfonylurea initiation among women with type 2 diabetes. Because this comparison was not made to placebo in an RCT and given the observational design with potential for residual confounding, causality cannot be inferred.
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