Comparative risk of serious hypoglycemia with oral antidiabetic monotherapy: A retrospective cohort study. Issue 1 (6th November 2017)

• Record Type: Journal Article
• Authors: Leonard, Charles E.; Han, Xu; Brensinger, Colleen M.; Bilker, Warren B.; Cardillo, Serena; Flory, James H.; Hennessy, Sean
• Is Part Of: Pharmacoepidemiology and drug safety. Volume 27:Issue 1(2018)
• Page Start: 9
• Page End: 18
• Publication Date: 2017-11-06
• Subjects: hypoglycemia -- meglitinide -- metformin -- pharmacoepidemiology -- sulfonylurea compounds -- thiazolidinedione; Pharmacoepidemiology -- Periodicals; Chemotherapy -- Periodicals; Epidemiology -- Periodicals; 615.705
• DOI: 10.1002/pds.4337
• Languages: English
• ISSNs: 1053-8569

Abstract

Abstract: Purpose: To examine and compare risks of serious hypoglycemia among antidiabetic monotherapy‐treated adults receiving metformin, a sulfonylurea, a meglitinide, or a thiazolidinedione. Methods: We performed a retrospective cohort study of apparently new users of monotherapy with metformin, glimepiride, glipizide, glyburide, pioglitazone, rosiglitazone, nateglinide, or repaglinide within a dataset of Medicaid beneficiaries from California, Florida, New York, Ohio, and Pennsylvania. We did not include users of dipeptidyl peptidase‐4 inhibitors, glucagon‐like peptide‐1 agonists, or sodium‐glucose co‐transporter 2 inhibitors. We identified serious hypoglycemia outcomes within 180 days following new use using a validated, diagnosis‐based algorithm. We calculated age‐ and sex‐standardized outcome occurrence rates for each drug and generated propensity score–adjusted hazard ratios vs metformin using Cox proportional hazards regression. Results: The ranking of standardized occurrence rates of serious hypoglycemia was glyburide > glimepiride > glipizide > repaglinide > nateglinide > rosiglitazone > pioglitazone > metformin. Rates were increased for all study drugs at higher average daily doses. Adjusted hazard ratios (95% confidence intervals) vs metformin were 3.95 (3.66‐4.26) for glyburide, 3.28 (2.98‐3.62) for glimepiride, 2.57 (2.38‐2.78) for glipizide, 2.03 (1.64‐2.52) for repaglinide, 1.21 (0.89‐1.66) for nateglinide, 0.90 (0.75‐1.07) for rosiglitazone, and 0.80 (0.68‐0.93) for pioglitazone. Conclusions: Sulfonylureas were associated with the highest rates of serious hypoglycemia. Among all study drugs, the highest rate was seen with glyburide. Pioglitazone was associated with a lower adjusted hazard for serious hypoglycemia vs metformin, while rosiglitazone and nateglinide had hazards similar to that of metformin.