{"title":"2型糖尿病患者的血糖水平和心血管事件：不同降糖电位药物的队列研究","authors":"Yi-Cheng Lin, Chih-Wei Chen, Ling-Ya Huang, Bi-Li Chen, Yu-Hsuan Joni Shao, Chun-Yao Huang","doi":"10.1038/s41598-025-10215-7","DOIUrl":null,"url":null,"abstract":"<p><p>Research indicates a U-shaped association between mortality and glycated hemoglobin (HbA1c) levels in patients receiving sulfonylurea or insulin. However, the relationship between glucose levels and cardiovascular events in patients on novel agents with a lower hypoglycemic potential remains unknown. This study was aimed to examine the association between cardiovascular events and HbA1c in patients with type 2 diabetes receiving drugs with different hypoglycemic potentials. This is an observational cohort study using a multicenter electronic medical record database. This study included patients who received a diagnosis of type 2 diabetes between 2009 and 2020 and received non-insulin antidiabetic drugs. These drugs were divided into drugs with a high-hypoglycemic-risk (sulfonylurea and meglitinides) and drugs with a low-hypoglycemic-risk (incretin mimetics, sodium-glucose cotransporter-2 inhibitors, thiazolidinediones, and acarbose). The events of interest were mortality and major adverse cardiovascular events (MACEs). A total of 6,789 patients were included, with 3,191 patients in low-hypoglycemic-risk drugs cohort and 3,598 patients in high-hypoglycemic-risk drugs cohort. Both cohorts exhibited a U-shaped association between HbA1c levels and the risk of mortality and MACEs. Among patients receiving low-hypoglycemic-risk drugs, HbA1c levels of 6.7% and 6.8% were associated with the lowest risk of mortality and MACEs, respectively. Similarly, in patients receiving high-hypoglycemic-risk drugs, the lowest risk of mortality and MACEs was observed at HbA1c levels of 6.8% and 7.2%, respectively. Both low and high HbA1c levels were associated with an increased risk of mortality and cardiovascular events, whereas intermediate levels were linked to the lowest risk. These findings support a U-shaped association between glycemic control and adverse outcomes in patients with type 2 diabetes receiving non-insulin-based therapies.</p>","PeriodicalId":21811,"journal":{"name":"Scientific Reports","volume":"15 1","pages":"24852"},"PeriodicalIF":3.9000,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318049/pdf/","citationCount":"0","resultStr":"{\"title\":\"Glycemic levels and cardiovascular events in type 2 diabetes: A cohort study of drugs with different hypoglycemic potentials.\",\"authors\":\"Yi-Cheng Lin, Chih-Wei Chen, Ling-Ya Huang, Bi-Li Chen, Yu-Hsuan Joni Shao, Chun-Yao Huang\",\"doi\":\"10.1038/s41598-025-10215-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Research indicates a U-shaped association between mortality and glycated hemoglobin (HbA1c) levels in patients receiving sulfonylurea or insulin. However, the relationship between glucose levels and cardiovascular events in patients on novel agents with a lower hypoglycemic potential remains unknown. This study was aimed to examine the association between cardiovascular events and HbA1c in patients with type 2 diabetes receiving drugs with different hypoglycemic potentials. This is an observational cohort study using a multicenter electronic medical record database. This study included patients who received a diagnosis of type 2 diabetes between 2009 and 2020 and received non-insulin antidiabetic drugs. These drugs were divided into drugs with a high-hypoglycemic-risk (sulfonylurea and meglitinides) and drugs with a low-hypoglycemic-risk (incretin mimetics, sodium-glucose cotransporter-2 inhibitors, thiazolidinediones, and acarbose). The events of interest were mortality and major adverse cardiovascular events (MACEs). A total of 6,789 patients were included, with 3,191 patients in low-hypoglycemic-risk drugs cohort and 3,598 patients in high-hypoglycemic-risk drugs cohort. Both cohorts exhibited a U-shaped association between HbA1c levels and the risk of mortality and MACEs. Among patients receiving low-hypoglycemic-risk drugs, HbA1c levels of 6.7% and 6.8% were associated with the lowest risk of mortality and MACEs, respectively. Similarly, in patients receiving high-hypoglycemic-risk drugs, the lowest risk of mortality and MACEs was observed at HbA1c levels of 6.8% and 7.2%, respectively. Both low and high HbA1c levels were associated with an increased risk of mortality and cardiovascular events, whereas intermediate levels were linked to the lowest risk. These findings support a U-shaped association between glycemic control and adverse outcomes in patients with type 2 diabetes receiving non-insulin-based therapies.</p>\",\"PeriodicalId\":21811,\"journal\":{\"name\":\"Scientific Reports\",\"volume\":\"15 1\",\"pages\":\"24852\"},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2025-08-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318049/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Scientific Reports\",\"FirstCategoryId\":\"103\",\"ListUrlMain\":\"https://doi.org/10.1038/s41598-025-10215-7\",\"RegionNum\":2,\"RegionCategory\":\"综合性期刊\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MULTIDISCIPLINARY SCIENCES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Scientific Reports","FirstCategoryId":"103","ListUrlMain":"https://doi.org/10.1038/s41598-025-10215-7","RegionNum":2,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MULTIDISCIPLINARY SCIENCES","Score":null,"Total":0}
Glycemic levels and cardiovascular events in type 2 diabetes: A cohort study of drugs with different hypoglycemic potentials.
Research indicates a U-shaped association between mortality and glycated hemoglobin (HbA1c) levels in patients receiving sulfonylurea or insulin. However, the relationship between glucose levels and cardiovascular events in patients on novel agents with a lower hypoglycemic potential remains unknown. This study was aimed to examine the association between cardiovascular events and HbA1c in patients with type 2 diabetes receiving drugs with different hypoglycemic potentials. This is an observational cohort study using a multicenter electronic medical record database. This study included patients who received a diagnosis of type 2 diabetes between 2009 and 2020 and received non-insulin antidiabetic drugs. These drugs were divided into drugs with a high-hypoglycemic-risk (sulfonylurea and meglitinides) and drugs with a low-hypoglycemic-risk (incretin mimetics, sodium-glucose cotransporter-2 inhibitors, thiazolidinediones, and acarbose). The events of interest were mortality and major adverse cardiovascular events (MACEs). A total of 6,789 patients were included, with 3,191 patients in low-hypoglycemic-risk drugs cohort and 3,598 patients in high-hypoglycemic-risk drugs cohort. Both cohorts exhibited a U-shaped association between HbA1c levels and the risk of mortality and MACEs. Among patients receiving low-hypoglycemic-risk drugs, HbA1c levels of 6.7% and 6.8% were associated with the lowest risk of mortality and MACEs, respectively. Similarly, in patients receiving high-hypoglycemic-risk drugs, the lowest risk of mortality and MACEs was observed at HbA1c levels of 6.8% and 7.2%, respectively. Both low and high HbA1c levels were associated with an increased risk of mortality and cardiovascular events, whereas intermediate levels were linked to the lowest risk. These findings support a U-shaped association between glycemic control and adverse outcomes in patients with type 2 diabetes receiving non-insulin-based therapies.
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