Comparison of diabetes‐associated secondary healthcare utilization between alternative oral antihyperglycaemic dual therapy combinations with metformin in patients with type 2 diabetes: an observational cohort study. Issue 6 (6th April 2015)

• Record Type: Journal Article
• Authors: Strongman, H.; D'Oca, K.; Langerman, H.; Das, R.
• Is Part Of: Diabetes, obesity & metabolism. Volume 17:Issue 6(2015:Jun.)
• Page Start: 573
• Page End: 580
• Publication Date: 2015-04-06
• Subjects: Diabetes -- Periodicals; Obesity -- Periodicals; Metabolism -- Disorders -- Periodicals; Clinical pharmacology -- Periodicals; 616.462
• DOI: 10.1111/dom.12458
• Languages: English
• ISSNs: 1462-8902

Abstract

<abstract abstract-type="main" id="dom12458-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="dom12458-sec-0001" sec-type="section"> <title>Aims</title> <p id="dom12458-para-0001">To compare diabetes‐associated secondary healthcare utilization in patients with type 2 diabetes (T2DM) prescribed sulphonylureas (SUs) versus other oral antihyperglycaemic agents (OHAs) as an add‐on to metformin monotherapy (metformin + SU vs metformin + OHA).</p> </sec> <sec id="dom12458-sec-0002" sec-type="section"> <title>Methods</title> <p id="dom12458-para-0002">This retrospective cohort study used data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics. Adults with T2DM initiated on metformin + SU or metformin + OHA from April 2003 to March 2012 were identified. Patients were matched using propensity scores. Diabetes‐associated secondary healthcare visits were counted from >6 months post‐initiation of dual therapy until treatment change or end of follow‐up. Outcomes were calculated as rate ratios, adjusted for over‐dispersion using negative binomial regression and propensity score for covariates.</p> </sec> <sec id="dom12458-sec-0003" sec-type="section"> <title>Results</title> <p id="dom12458-para-0003">After propensity score matching, 1704 patients were included in each cohort. For the primary objective (diabetes‐associated inpatient and outpatient visits combined), the metformin + SU cohort had a directionally higher rate of diabetes‐associated secondary healthcare utilization than the metformin + OHA cohort [adjusted rate ratio 1.12, 95% confidence interval (CI) 0.97–1.29]. For the secondary outcomes, the adjusted rate ratio was 1.38 (95% CI 0.95–2.00) for inpatient admissions and 1.10 (95% CI 0.95–1.28) for outpatient visits. Macrovascular complications, accounting for 77.2% of inpatient admissions, occurred at a statistically significantly higher rate in the metformin + SU cohort than in the metformin + OHA cohort (adjusted rate ratio 1.77, 95% CI 1.15–2.71).</p> </sec> <sec id="dom12458-sec-0004" sec-type="section"> <title>Conclusions</title> <p id="dom12458-para-0004">This study found a statistically significant higher rate of inpatient admissions for macrovascular complications and cardiology outpatient visits and, overall, a directionally higher rate of secondary healthcare utilization for patients prescribed metformin + SU than for those prescribed metformin + OHA. This adds to the evidence that long‐term and health economic outcomes should be considered in treatment decisions for patients with type 2 diabetes.</p> </sec> </abstract>