| アブストラクト | PURPOSE: The magnitude of the risk of severe hypoglycemia associated with sulfonylureas as the initial treatment for type 2 diabetes in the real-world setting is unknown. We assessed the risk of severe hypoglycemia associated with initiating monotherapy with sulfonylurea compared with metformin for the treatment of type 2 diabetes. METHODS: By using the UK Clinical Practice Research Datalink and Hospital Episode Statistics linked to the Office for National Statistics, we identified a cohort of patients with type 2 diabetes who initiated sulfonylureas or metformin monotherapy between April 1, 1998, and December 31, 2012, with follow-up until December 31, 2013. Sulfonylurea users were matched one-to-one to metformin users by high-dimensional propensity scores. Hazard ratios (HRs) and 95% confidence intervals (CIs) of severe hypoglycemia, defined as requiring hospitalization, were estimated using Cox proportional hazards models comparing sulfonylureas with metformin monotherapy. RESULTS: The study cohort consisted of 14,012 initiators of sulfonylureas matched to 14,012 initiators of metformin. The mean treated follow-up time was 1.41 (standard deviation, 1.84) years. Use of sulfonylurea was associated with an elevated incidence of severe hypoglycemia compared with metformin as the initiating monotherapy for type 2 diabetes (incidence rate, 2.4/1000 person-years; 95% CI, 1.90-2.90; HR, 4.53; 95% CI, 2.76-7.45). CONCLUSIONS: Sulfonylureas, when prescribed as the initiating monotherapy for the treatment of type 2 diabetes, is associated with a 4.5-fold increase in the risk of severe hypoglycemia. Given the negative consequences of this outcome, clinicians should consider alternative hypoglycemic agents when metformin is not tolerated or contraindicated. |
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| ジャーナル名 | The American journal of medicine |
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| 投稿日 | 2017/10/17 |
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| 投稿者 | Yu, Oriana; Azoulay, Laurent; Yin, Hui; Filion, Kristian B; Suissa, Samy |
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| 組織名 | Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital,;Montreal, Canada; Division of Endocrinology, Jewish General Hospital, Montreal,;Canada.;Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational;Health, McGill University, Montreal, Canada; Gerald Bronfman Department of;Oncology, McGill University, Montreal, Canada.;Montreal, Canada.;Health, McGill University, Montreal, Canada; Department of Medicine, McGill;University, Montreal, Canada.;University, Montreal, Canada. Electronic address: samy.suissa@mcgill.ca. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/29032229/ |
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