维拉帕米可减少2型糖尿病发病率

Verapamil Use Is Associated With Reduction of Newly Diagnosed Diabetes Mellitus

目的:钙通道阻滞剂(CCB类药物)尤其是维拉帕米对于2型糖尿病(T2DM)的有益作用现已被发现。该研究对比成年人口服维拉帕米和其他CCB类药物T2DM的发生率。方法:回顾分析2000年至2011年国家健康保险数据库,T2DM的定义根据国际疾病分类临床修订第九版(ICD-9)。结果:在这个药物研究中,匹配队列分析以及各种混杂的因素揭示维拉帕米以及CCB类药物有一个独特的作用那就是降低2型糖尿病的发病风险。不同组口服维拉帕米的疗效一致,其中老年患者的获益更大。结论:对于没有糖尿病病史的人,口服维拉帕米对比其他CCB类药物可以显著降低T2DM的发病率。

Objective:To investigate the mechanism of the beneficial effect of calcium-channel blockers(CCBs),especially verapamil,on the development of type 2 diabetes mellitus(T2DM).This study compared the incidence of T2DM in adults prescribed oral verapamil and propensity score-matched adults prescribed other oral CCBs.Methods:This retrospective population-based cohort study was performed by searching Taiwan's National Health Insurance Research Database from 2000 to 2011.T2DM was defined according to the International Classification of Diseases,Ninth Revision,Clinical Modification.Results:During follow-up periods of 41,958 and 42,118 person-years,269 of 4930 patients in the verapamil cohort and 340 of 4930 patients in the matched cohort,respectively,developed T2DM.The incidence rates were 6.41 and 8.07 per 1000 population per year among verapamil and other CCB users,respectively.The adjusted hazard ratio(HR)for T2DM associated with use of verapamil(vs.other CCBs)was 0.80[95%confidence interval(CI),0.68 to 0.94;P=0.006].After exclusion of patients followed for,180 days or,365 days(to avoid bias derived from delayed diagnosis),adjusted HRs remained significant[0.79(95%CI,0.67 to 0.93;P=0.005)and 0.77(95%CI,0.65 to 0.91;P=0.002),respectively].Only the interaction term for age was significant(P=0.009).Verapamil had a more prominent effect on patients aged older than 65 years(P,0.001).Conclusions:In patients with no known history of diabetes mellitus,oral verapamil use was associated with a decreased incidence of T2DM compared with other CCBs.