All-cause and cardiovascular mortality associated with sulphonylurea and metformin therapy in type 2 diabetes. (3rd April 2018)

• Record Type: Journal Article
• Authors: Ioacara, Sorin; Guja, Cristian; Reghina, Aura; Martin, Sorina; Sirbu, Anca; Fica, Simona
• Is Part Of: Endocrine research. Volume 43:Number 2(2018)
• Page Start: 97
• Page End: 105
• Publication Date: 2018-04-03
• Subjects: Metformin -- sulphonylurea -- mortality; Endocrinology, Experimental -- Periodicals; Endocrinology -- Periodicals; Endocrinology -- Periodicals; Research -- Periodicals; 616.4
• DOI: 10.1080/07435800.2017.1422745
• Languages: English
• ISSNs: 0743-5800

Abstract

ABSTRACT: Purpose : To test the hypothesis that cumulative exposure to sulphonylurea (SU) or metformin (MET) have different effects on mortality when taken as a replacement or add-on of one for the other.Methods : All consecutive diabetes patients aged over 20 years were screened at their first diabetes outpatient visit between 2001 and 2008 ( n = 79869). Only patients on MET ( n = 11374) or SU ( n = 18502) monotherapy were retained. All patients were followed up for death until December 31, 2011, but censored at first exposure to anything else besides MET/SU. Adjusted time-dependent Cox regression and competing risk regression analysis, with daily updates of treatment modalities were performed.Results : Mean age was 62.1 ± 11.2 years and follow-up was 4.6 ± 3.2 years (138496 person-years). Adjusted all-cause and cardiovascular mortality rates were significantly higher in MET as compared with SU group. All-cause mortality hazard ratios (HR) for cumulative time exposure were as follows: HR 0.956 (95%CI 0.951–0.962, p < 0.001) for SU added to MET, HR 1.092 (95%CI 1.087–1.096, p < 0.001) for SU replacing MET, HR 0.979 (95%CI 0.975–0.983, p < 0.001) for MET added to SU, and HR 1.127 (95%CI 1.118–1.136, p < 0.001) for MET replacing SU.Conclusion(s) : The effect on all-cause mortality was beneficial for MET+SU combined therapy, but deleterious for either SU replacing MET, or MET replacing SU. There were no major outcome differences when analyzing individual SU, or specific mortality.