首页> 外文期刊>Archives of Internal Medicine >Long-term effects of metformin on metabolism and microvascular and macrovascular disease in patients with type 2 diabetes mellitus.
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Long-term effects of metformin on metabolism and microvascular and macrovascular disease in patients with type 2 diabetes mellitus.

机译:长期二甲双胍对代谢的影响微血管和macrovascular疾病2型糖尿病患者。

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BACKGROUND: We investigated whether metformin hydrochloride has sustained beneficial metabolic and (cardio) vascular effects in patients with type 2 diabetes mellitus (DM2). METHODS: We studied 390 patients treated with insulin in the outpatient clinics of 3 hospitals in a randomized, placebo-controlled trial with a follow-up period of 4.3 years. Either metformin hydrochloride, 850 mg, or placebo (1-3 times daily) was added to insulin therapy. The primary end point was an aggregate of microvascular and macrovascular morbidity and mortality. The secondary end points were microvascular and macrovascular morbidity and mortality, as separate aggregate scores. In addition, effects on hemoglobin A(1c) (HbA(1c)), insulin requirement, lipid levels, blood pressure, body weight, and body mass index were analyzed. RESULTS: Metformin treatment prevented weight gain (mean weight gain, -3.07 kg [range, -3.85 to -2.28 kg]; P < .001), improved glycemic control (mean reduction in HbA(1c) level, 0.4% percentage point [95% CI, 0.55-0.25]; P < .001) (where CI indicates confidence interval), despite the aim of similar glycemic control in both groups, and reduced insulin requirements (mean reduction, 19.63 IU/d [95% CI, 24.91-14.36 IU/d]; P < .001). Metformin was not associated with an improvement in the primary end point. It was, however, associated with an improvement in the secondary, macrovascular end point (hazard ratio, 0.61 (95% CI, 0.40-0.94; P = .02), which was partly explained by the difference in weight. The number needed to treat to prevent 1 macrovascular end point was 16.1 (95% CI, 9.2-66.6). CONCLUSIONS: Metformin, added to insulin in patients with DM2, improved body weight, glycemic control, and insulin requirements but did not improve the primary end point. Metformin did, however, reduce the risk of macrovascular disease after a follow-up period of 4.3 years. These sustained beneficial effects support the policy to continue metformin treatment after the introduction of insulin in any patient with DM2, unless contraindicated. Trial Registration ClinicalTrials.gov Identifier: NCT00375388.
机译:背景:我们研究了二甲双胍盐酸持续有益的代谢(有氧运动)患者的血管的影响2型糖尿病(DM2)。研究了390例患者用胰岛素治疗三医院的门诊随机、安慰剂对照试验年限为4.3年。盐酸、850毫克或安慰剂(1 - 3倍每日)添加到胰岛素治疗。终点是一个聚合的微血管macrovascular发病率和死亡率。次要终点是微血管和macrovascular发病率和死亡率,单独的总分数。在血红蛋白A (1 c) (HbA (1 c)),胰岛素要求,血脂水平、血压、身体体重和身体质量指数进行了分析。结果:二甲双胍治疗预防体重获得(平均体重增加,[-3.85,-3.07公斤-2.28公斤);(平均减少HbA (1 c)水平,0.4%的比例点(95% CI, 0.55 - -0.25);表示置信区间),尽管目标相似的两组血糖控制减少胰岛素需求(意味着减少,19.63是要/ d黑95% CI, 24.91-14.36是要/ d铝;二甲双胍与改善无关主要终点。改善二次,macrovascular终点(风险比0.61 (95%CI, 0.40 - -0.94;用重量的差异来解释。需要治疗,以防止1 macrovascular结束点为16.1 (95% CI, 9.2 - -66.6)。二甲双胍,DM2患者胰岛素,体重,改善血糖控制胰岛素需求但没有改善主要终点。macrovascular疾病后的风险年限为4.3年。有利影响政策继续支持二甲双胍治疗后的引入胰岛素在任何DM2患者,除非禁忌。ClinicalTrials . gov Identifier: NCT00375388。

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