Association between antidiabetic drugs and the incidence of atrial fibrillation in patients with type 2 diabetes: A nationwide cohort study in South Korea. (April 2023)

• Record Type: Journal Article
• Authors: Kim, Sunyoung; Park, So Young; Kim, Bongseong; Min, Chanyang; Cho, Wonyoung; Yon, Dong Keon; Kim, Joo Young; Han, Kyung-Do; Rhee, Eun-Jung; Lee, Won-Young; Rhee, Sang Youl
• Is Part Of: Diabetes research and clinical practice. Volume 198(2023)
• Publication Date: 2023-04
• Subjects: Atrial fibrillation -- Metformin -- Thiazolidinedione -- Cardiovascular complication; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2023.110626
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: Why did we undertake this study? We aimed to investigate the possibility of a difference in the AF preventive effect of antidiabetic drugs through a national cohort-based real-world data analysis that classifies the entire adult population. What is the specific question(s) we wanted to answer? Which antidiabetic drugs are most effective in preventing AF? What did we find? The combination therapy of MET and TZD is the most effective antidiabetic drug for preventing AF in patients with type 2 diabetes. What are the implications of our findings? Through this study, real world evidence was prepared for the effective results of MET and TZD combination therapy, which is widely used in clinical practice, for AF. Abstract: Background: Although diabetes is a risk factor for atrial fibrillation (AF), studies on the AF risk according to the antidiabetic drugs are lacking. This study evaluated the effects of antidiabetic drugs on AF incidence in Korean patients with type 2 diabetes. Methods: We included 2, 515, 468 patients with type 2 diabetes from the Korean National Insurance Service database without a history of AF who underwent health check-ups between 2009 and 2012. Newly diagnosed AF incidence was recorded until December 2018 according to the main antidiabetic drug combinations used in the real world. Results: Of the patients included (mean age, 62 ± 11 years; 60 % men), 89, 125 were newly diagnosed with AF. Metformin (MET) alone (hazard ratio [HR] 0.959, 95 % CI 0.935–0.985) and MET combination therapy (HR < 1) significantly decreased the risk of AF compared to the no-medication group. The antidiabetic drugs consistently showing a protective effect against AF incidence were MET (HR 0.977, 95 % CI 0.964–0.99) and thiazolidinedione (TZD; HR 0.926, 95 % CI 0.898–0.956), even after adjusting for various factors. Moreover, this protective effect was more remarkable with MET and TZD combination therapy (HR 0.802, 95 % CI 0.754–0.853) than with other drug combinations. In the subgroup analysis, the preventive effect of MET and TZD treatment against AF remained consistent, regardless of age, sex, duration, and diabetes severity. Conclusion: The combination therapy of MET and TZD is the most effective antidiabetic drug for preventing AF in patients with type 2 diabetes.