| Objective: diabetes is a disease of global public health that imposes a huge burden on society and individuals.90% of these are type 2diabetes mellitus(T2DM),characterized by insulin resistance and lack of insulin secretion.Lifestyle modification,oral antidiabetic agents,injection of noninsulin injectables and/or different type of insulin are the main means of treating T2DM patients at present.Early,efficient control of glycemia safely and control of multiple cardiovascular risk factors are currently status of art to avoid incidence of diabetic complications and elongation of life expectance.Diabetic management based on control of glycemic control with conventional antidiabetic agents(ATD)although could decrease the incidence of microvascular complications,but fail to decrease the incidence of cardiovascular complication and all-cause mortality.Recently,results of studies of glucagon-like peptide-1 receptor agonists(GLP-1RA)and sodium glucose cotransporter 2 inhibitors(SGLT-2i)in cardiovascular outcomes trials(CVOT)and renal outcomes trials(ROT)achieved significant cardiovascular and mortality benefits while more efficient and safe control of glycemia.Therefore,current paradigm of diabetes management has switched a glycocentric modality to a CVOT priority to selection antidiabetic agents that have proved evidence on atherosclerotic cardiovascular disease(ASCVD),heart failure(HF),and chronic kidney disease(CKD)benefits.Even in patients without ASCVD or high risk factors,HF,and CKD,achievement of glycemic goal with agents of efficient,safe and weight control benefits is also promoted.However,because medicines are not fully available and habitual practice of physician might not fully follow the update of current consensus or recommendations of clinical treatment,we therefore investigated the trend in antidiabetic agents use or selection in our patients discharged during January 2017 to December 2021 and possible influencing factors over 5 years.Methods: Anthropologic,laboratory,chronic complications,comorbidities data,profile of antidiabetic medication at admission and discharge of patients with T2DM admitted to the inpatient department of endocrinology and metabolism of the author’s hospital between January2017 and December 2021 were collected.Patients who had used on steroids three months prior to admission or currently on steroids,who were hospitalized due to critical illness,secondary diabetes due to other possible causes,on not known medicines,and with type 1 diabetes mellitus were excluded;When a patient was hospitalized several times in the same year among 2017-2021,only the data from last admission was counted,but when the patient was admitted several times not in the same year but in different years,the data of the patient were retracted for analysis.Data from 3865 patients were used for final analysis.Results:1.In aspect of glycemic control,fasting glucose(FBG)control and A1C decreased from 2017 to 2021(P < 0.05),but no trend was observed for 2-h postprandial blood glucose(2hBG).The most common chronic complication was peripheral neuropathy(83.4%),while diabetic foot was the least,with only 14 cases in 5 years,and peripheral vascular complications(neck vessels + lower limb vessels)showed increased(P <0.001),while coronary heart disease(CHD)peak in 2020(13.6%).No differences in change of prevalence of renal(35%)and cerebrovascular(7.5%)complications between each year(P > 0.05).2.The number of ATDs used before admission during 2017-2021 were 1.53 per person categorically,and metformin was the most frequently used(41.3%).On discharge,the number of ATDs prescribed by physician in charge was 2.23 on average,with metformin was still the frequently used(50.2%).Over the five years,the number of ATDs before admission and at discharge increased from 2017 until 2021(P < 0.001).3.On specific ATDs,before admission α-glucosidase inhibitor(AGIs)was frequently used in 2017(34.7%),and then decreased after 2018.Metformin was the most frequently used and remained stable.,GLP-1RA,and SGLT-2i increased years on.At discharge,AGI was used frequent(>50%)from 2017 until 2019,decreased sharply(<30%)in 2020 and 2021.Metformin remained high(50%)from 2017 until 2019 and decreased some after(45%-48%).SGLT-2i use increased from 2017(0.4%)to 2019(11.7%),and increased sharply to over 50% and surpassed metformin in2020,2021,was the most frequently used oral ATD.No significant change of the use of Dipeptidase type 4 inhibitors(DPP-4i)was observed and remained constant(9.9%-17.9%)during 2017-2021.GLP-1RAs increased from 3% in 2017 to 24.7% in 2021.On contrary the use of secretagogues(sulfonylureas,glinides,from 5.2% to 1.3%),insulin intensive therapy(from 17.9% to 9.8%)decreased significantly(P<0.001),while basal insulin(insulin glargine,23.3%-27.7%)and premix insulin(15.4%-20%)remained unchanged(P>0.05).4.By using GLP-1RA or not during years of 2017-2021 as dependent variable,HbA1c、FBG、1hBG、2hBG、fasting C peptide(FCP),1hCP,2hCP,body mass index(BMI),total cholesterol(TC),triglycerides(Trg),vascular complication(peripheral and cardiovascular,ASCVD),hypertension(HTN),CKD,and ACR as the independent variables,logistic binary regression analysis resulted higher BMI,Trg,A1C,and ACR as independent risk factors with BMI as the main influencing factor.For SGLT-2i during 2019-2021,CHD,CKD,A1C,Trg,and BMI as the independent risk factors,with CHD as main influencing factor.5.The use of SGLT-2i was significantly higher than that of GLP-1RA(4% vs 1.9% before admission,P < 0.001,and 20.2% vs 10.3% at discharge,P < 0.001).Conclusion: With the introduction of GLP-1RA in 2017 and SGLT-2is in 2019 in China and the promotion by recent guidelines,the selection of GLP-1RA from 2017 and SGLT-2is from 2019 increased significantly by years,especially SGLT-2i use in patients with ASCVD and CKD,but the selection of GLP-1RAs is still insufficient.As for the benefit findings of GLP-RA from CVOT trials is evident,the promotion of application GLP-RA in patients with diabetes,especially with ASCVD and high-risk individuals is still needed. |
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