口服糖尿病药物的持久性:到达A1c基线的时间和初级保健提供者常用口服药物的回顾。

Endocrinology, diabetes and metabolism journal Pub Date : 2018-09-01 Epub Date: 2018-07-08
Lavanya Cherukuri, Michael S Smith, John A Tayek
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引用次数: 0

摘要

简介:在过去的几年里,仿制药的成本比历史上任何时候都要高。虽然医疗保险涵盖了这些费用的大部分,但与安慰剂相比,卫生保健专业人员可以更好地提供作用时间最长的药物。这将节省医疗费用,提高处方的准确性。方法:以安慰剂为关键词对PubMed中的论文进行检索。该研究必须至少持续2年才能评估A1c随时间的变化。主要终点是达到A1c中性的时间(在单次口服药物的最大剂量下,A1c恢复到基线)。如果95% CI超过基线,则认为该药物为中性。对类别中每种药物的中性时间进行平均,并对每种药物的类别效果进行总结。结果:DPP-4和磺脲类药物的有效治疗时间为3-4年,而使用二甲双胍达到A1c中性需要5年时间。相比之下,罗格列酮和吡格列酮达到A1c中性的预计时间约为6-8年。虽然只有少数关于SGLT-2类药物的研究发表,但使用卡格列净和全剂量恩帕格列净达到A1c中性的时间也为6-8年。结论:在A1c恢复到基线水平之前,二甲双胍似乎有5年的持续效果。磺脲类和DPP-4抑制剂类药物具有最短的耐久性,在3.3至4.4年之间。相比之下,SGLT-2类药物和TZD类药物达到A1c中性的预计时间为6-8年。与安慰剂相比,糖尿病治疗的持续时间应与测试的药物一起列出,以便提供者可以明智地选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

The durability of oral diabetic medications: Time to A1c baseline and a review of common oral medications used by the primary care provider.

The durability of oral diabetic medications: Time to A1c baseline and a review of common oral medications used by the primary care provider.

Introduction: Cost of generic medications has risen more in the past few years than any other time in history. While medical insurance covers much of these costs, health care professionals can better provide medications that have the longest duration of action when compared to placebo-treated controls. This will save health care costs and improve prescribing accuracy.

Methods: Papers in PubMed were identified with keywords placebo. The study must be at least 2 years in length to evaluate the change in A1c over time. The primary endpoint was time to A1c neutrality (return of A1c to baseline at a maximum dose of single oral agent). A medication would be considered at neutrality if the 95% CI crossed baseline. Time to neutrality was averaged for each medication within the class and each summarized for class effect.

Results: Effective therapy for the DPP-4 and sulfonylurea classes of medications are 3-4 years as compared to a 5-year time to A1c neutrality for metformin usage. In comparison, the projected time to A1c neutrality was approximately 6-8 years for rosiglitazone and pioglitazone. While only a few studies have been published in the SGLT-2 class of medication, the time to A1c neutrality was also 6-8 years with Canagliflozin and full dosage of Empagliflozin.

Conclusion: Metformin appears to have a 5-year duration of effect before the A1c returns to baseline. The sulfonylureas and DPP-4 inhibitors class of medications have one of the shortest durability which ranges between 3.3 to 4.4 years. In contrast, the SGLT-2 class of medication and the TZD class of medications has a projected time to A1c neutrality from 6-8 years. Diabetic duration of therapy as compared to placebo should be listed with those medications tested so the provider can choose wisely.

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