世代追蹤研究第2型糖尿病患者使用α-葡萄糖苷酶抑製劑和乾癬疾病的風險

研究目的：本研究旨探討第二型糖尿病患者使用α-葡萄糖苷酶抑製劑與罹患乾癬疾病（即乾癬和乾癬關節炎）風險的關聯性。研究方法及資料：本研究使用1999至2013年台灣健保資料庫糖尿病人抽樣歸人檔數據，選擇2003年至2012年新診斷第二型糖尿病患者且有接受降血糖藥物治療的患者，排除先前有乾癬疾病病史、起始用藥使用非二甲雙胍降血糖藥物、年紀低於二十歲或大於一百歲者及累積降血糖藥物使用小於90天者，最後篩選出1,390名接受二甲雙胍及α-葡萄糖苷酶抑製劑治療的患者為暴露組，47,514名單一接受二甲雙胍治療的患者為非暴露組。將兩組依照年齡、性別及使用糖尿病藥物的指標日期做一比十比例傾向分數配對，控制干擾因子，如年齡、性別、糖尿病罹患時間、共病症等，之後使用Cox比例風險模型及具時間相依共變數分析α-葡萄糖苷酶抑製劑的使用與罹患乾癬疾病風險之間的關聯性，以95%信賴區間(CI)呈現的風險比。研究結果：傾向分數配對之前，暴露組共有1,390位患者，非暴露組共有47,514位患者，傾向分數匹配後，控制兩組年齡、性別、糖尿病罹患時間、共病症等干擾因子之後，暴露組有1,299位患者，非暴露組共有12,990位患者暴露組，Cox比例風險模型多變項分析顯示第二型糖尿病患者罹患乾癬疾病暴露組風險比，(1)已罹病死亡或最後一次門診當作終點為2.87，95%信賴區間為1.04–7.97；α-葡萄糖苷酶抑製劑大於中位數劑量時為6.39，95%信賴區間為2.28–17.96；(2)停用α-葡萄糖苷酶抑製劑30天後為8.77，95%信賴區間為1.58–48.58；α-葡萄糖苷酶抑製劑劑量大於中位數劑量時為36.11，95%信賴區間為5.60–232.80；(3)停用α-葡萄糖苷酶抑製劑 90天後為4.58，95%信賴區間為1.51–13.89；α-葡萄糖苷酶抑製劑大於中位數劑量時為9.45，95%信賴區間為3.09–28.86；(4)停用α-葡萄糖苷酶抑製劑180天後為3.29，95%信賴區間為1.16–9.36；α-葡萄糖苷酶抑製劑大於中位數劑量時為6.63，95%信賴區間為2.30–19.08，另具時間相依共變數分析方法結果趨勢也如同多變項分析。結論與建議：以全國人口為對象的研究結果顯示使用α-葡萄糖苷酶 抑製劑治療及較高劑量可能增加第二型糖尿病患者罹患乾癬疾病的風險，但造成的相關性是可逆的，

To investigate the association of alpha-glucosidase inhibitors (AGIs) use and the risk of psoriatic disease (i.e., psoriasis and psoriatic arthritis) in type 2 diabetes mellitus (T2DM) patients treated with metformin. Using the 1999-2013 Taiwanese longitudinal cohort of diabetic database, we identified T2DM patients initiating hypoglycemic treatment from 2003 to 2012. After excluding those who had a history of psoriatic disease (ICD-9-CM code 696.0–1) before DM diagnosis, who received antidiabetic treatment accumulated less than 90 days, those aged <20 or >100 years, we identified 1,390 patients who received metformin combined AGIs (AGIs exposure group) and 47,514 patients who received metformin only therapy (comparison group). We matched the two groups 1:10 for age, sex, and index date of DM drug use from this cohort. The association between use of AGIs and the risk of psoriatic disease was analyzed by using the Cox proportional hazard model and time-dependent covariates for factors shown as hazard ratios (HRs) with 95% confidence intervals (CIs) after controlling for We identified 1,390 patients in the metformin combine AGIs group and 47,514 patients in the metformin group. After adjusting for potential confounders, the risk of psoriatic disease was associated with metformin combine AGIs use when interrupted AGIs 30 days (HR 8.77, 95% CI, 1.58–48.5), and higher AGIs dose, besides, the risk declines over period of AGIs suspend time. This population-based study suggested that use of AGIs with dose dependent manner may be associated with an increased risk of psoriatic disease in treated type 2 DM patients, whereas the effect is reversible.