Risk of overall mortality and cardiovascular events in patients with type 2 diabetes on dual drug therapy including metformin: A large database study from the Cleveland Clinic. (29th June 2015)

• Record Type: Journal Article
• Authors: Kannan, Subramanian; Pantalone, Kevin M.; Matsuda, Simone; Wells, Brian J.; Karafa, Matthew; Zimmerman, Robert S.
• Is Part Of: Journal of diabetes. Volume 8:Number 2(2016:Mar.)
• Page Start: 279
• Page End: 285
• Publication Date: 2015-06-29
• Subjects: congestive heart failure -- dipeptidyl peptidase‐4 inhibitors -- mortality -- sulfonylureas -- thiazolidinediones; 充血性心力衰竭 -- 二肽基肽酶‐4抑制剂 -- 死亡率 -- 磺酰脲类 -- 噻唑烷二酮类; Diabetes -- Periodicals; 618.3646005
• DOI: 10.1111/1753-0407.12301
• Languages: English
• ISSNs: 1753-0393

Abstract

Abstract: Background: The aim of the present study was to assess the risk of overall mortality, coronary artery disease (CAD), and congestive heart failure (CHF) in patients with type 2 diabetes mellitus (T2DM) treated with metformin (MF) and an additional antidiabetic agent. Methods: A retrospective cohort study was conducted using an academic health center enterprise‐wide electronic health record (EHR) system to identify 13 185 adult patients (>18 years) with T2DM from January 2008 to June 2013 and received a prescription for MF in combination with a sulfonylurea (SU; n = 9419), thiazolidinedione (TZD; n = 1846), dipeptidyl peptidase‐4 inhibitor (DPP‐4i; n = 1487), or a glucagon‐like peptide‐1 receptor agonist (GLP‐1a; n = 433). Multivariate Cox models with propensity analysis were used to compare cohorts, with MF+SU serving as the comparator group. Results: The mean (±SD) age was 60.6 ± 12.6 years, with 54.6% male and 75.8% Caucasians. The median follow‐up was 4 years. There were 1077 deaths, 1733 CAD events, and 528 CHF events in 55 100 person‐years of follow‐up. A higher risk of CHF was observed with MF+DPP‐4i use (hazard ratio [HR] 1.104; 95% confidence interval [CI] 1.04–1.17; P = 0.001). A trend towards improved overall survival for users of MF+TZD (HR 0.86; 95% CI 0.74–1.0; P = 0.05) and MF+GLP‐1a (HR 0.569; 95% CI 0.30–1.07; P = 0.08) was observed. No significant differences in the risk of CAD were identified. Conclusions: Consistent with recent studies, our results raise concern for an increased risk of CHF with use of DPP‐4i.