| アブストラクト | OBJECTIVE: To examine the effect of second-line treatments (insulin secretagogues, thiazolidinediones, glucagon-like peptide-1 (GLP-1) receptor agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors or sodium-glucose co-transporter 2 (SGLT-2) inhibitors) on time to insulin initiation among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted a retrospective cohort study using the Clinical Practice Research Datalink (CPRD) Aurum. Initiation of metformin monotherapy (1998-2021) defined base cohort entry, and initiation of second-line treatment (2013-2021) defined study cohort entry (time zero). After propensity score trimming, we applied inverse probability of treatment weighted Cox models to estimate the association between second-line agents and time to insulin initiation. The secondary outcome was time to treatment modification, defined as the addition of or switch to another antidiabetic drug class. RESULTS: Our analytic cohort included 64 404 patients; 44% initiated DPP-4 inhibitors, 36% insulin secretagogues, 18% SGLT-2 inhibitors, 1% thiazolidinediones and 3% GLP-1 receptor agonists. Over a mean follow-up of 2.9 years, initiation of TZDs, DPP-4 inhibitors, or SGLT-2 inhibitors was associated with a lower risk of insulin initiation than initiation of insulin secretagogues (HR [95% CI]: 0.59 [0.43-0.83], 0.75 [0.69-0.80] and 0.62 [0.56-0.68], respectively). For treatment modification, the risk was higher among TZD and DPP-4 inhibitor initiators, and slightly lower among SGLT-2 inhibitor initiators and GLP-1 receptor agonist initiators than among insulin secretagogue initiators. CONCLUSION: This study provides real-world evidence that TZDs, DPP-4 inhibitors and SGLT-2 inhibitors may offer an advantage over insulin secretagogues in delaying insulin initiation after metformin monotherapy. |
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| ジャーナル名 | Diabetes, obesity & metabolism |
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| Pubmed追加日 | 2026/8/7 |
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| 投稿者 | Yu, Ya-Hui; Zhang, Qi; Zapata-Bravo, Estefania; Platt, Robert W; Reynier, Pauline; Yu, Oriana H Y; Filion, Kristian B |
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| 組織名 | Department of Epidemiology, Rollin School of Public Health, Emory University,;Atlanta, Georgia, USA.;Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital,;Montreal, Quebec, Canada.;Departments of Medicine and of Epidemiology, Biostatistics and Occupational;Health, McGill University, Montreal, Quebec, Canada.;Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational;Division of Endocrinology, Jewish General Hospital, Montreal, Quebec, Canada. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/42563367/ |
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