Second line initiation of insulin compared with DPP-4 inhibitors after metformin monotherapy is associated with increased risk of all-cause mortality, cardiovascular events, and severe hypoglycemia

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Nyström, ThomasKarolinska Institutet (författare)

Second line initiation of insulin compared with DPP-4 inhibitors after metformin monotherapy is associated with increased risk of all-cause mortality, cardiovascular events, and severe hypoglycemia

Artikel/kapitelEngelska2017

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ELSEVIER IRELAND LTD,2017
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LIBRIS-ID:oai:DiVA.org:uu-319682
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-319682URI
https://doi.org/10.1016/j.diabres.2016.12.004DOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:135312736URI

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Språk:engelska
Sammanfattning på:engelska

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Aims: The objective of this nationwide study was to compare the risk of all-cause mortality, fatal and nonfatal cardiovascular disease (CVD), and severe hypoglycemia in patients with type 2 diabetes (T2D) on metformin monotherapy treatment starting second-line treatment with either insulin or dipeptidyl peptidase-4 inhibitor (DPP-4i). Methods: All patients with T2D in Sweden who initiated second-line treatment with insulin or DPP-4i after metformin monotherapy during 2007-2014 identified in the Swedish Prescribed Drug Register were followed for outcome in the Cause of Death and National Patient Registers. Insulin and DPP-4i patients were matched 1: 1 using propensity-score matching. Comparisons between groups were performed using unadjusted Cox regression models. Additionally, multivariate adjusted survival models were used to test the results using the full population without matching. Results: Of 27,767 mono-metformin-treated patients, 55.7% started insulin and 44.3% a DPP-4i, and after matching both groups had 9278 patients each. Median follow-up (patients years) times were 3.84 (37,578) and 3.93 (37,983) for insulin and DPP-4i-groups, respectively. Insulin compared with DPP-4i was associated with higher risk of subsequent all-cause mortality, fatal and nonfatal CVD, and severe hypoglycemia; adjusted HR (95% CI): 1.69 (1.45-1.96); 1.39 (1.21-1.61); and 4.35 (2.26-8.35), respectively. When performing multivariate adjusted analyses on the full population similar results were found. Conclusions: Initiation of insulin, compared with DPP-4i treatment, was associated with an increased risk of subsequent all-cause mortality, fatal and nonfatal CVD, and severe hypoglycemia. Results from randomized trials will be important to elucidate causal relationships.

Ämnesord och genrebeteckningar

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Endokrinologi och diabetes hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Endocrinology and Diabetes hsv//eng
Insulin
Type 2 diabetes
Dipeptidyl peptidase-4 inhibitor
Cardiovascular disease
Hypoglycemia
Outcome

Biuppslag (personer, institutioner, konferenser, titlar ...)

Bodegard, JohanAstraZeneca Nordic Baltic, Sodertalje, Sweden. (författare)
Nathanson, DavidKarolinska Institutet (författare)
Thuresson, MarcusStatisticon AB, Uppsala, Sweden. (författare)
Norhammard, AnnaKarolinska Inst, Dept Med, Cardiol Unit, Stockholm, Sweden.;Capio St Gorans Hosp, Stockholm, Sweden. (författare)
Eriksson, Jan W.Uppsala universitet,Klinisk diabetologi och metabolism(Swepub:uu)janer909 (författare)
Karolinska InstitutetAstraZeneca Nordic Baltic, Sodertalje, Sweden. (creator_code:org_t)

Sammanhörande titlar

Ingår i:Diabetes Research and Clinical Practice: ELSEVIER IRELAND LTD123, s. 199-2080168-82271872-8227

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Av författaren/redakt...: Nyström, Thomas; Bodegard, Johan; Nathanson, David; Thuresson, Marcu ...; Norhammard, Anna; Eriksson, Jan W.

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Endokrinologi oc ...

Artiklar i publikationen: Diabetes Researc ...

Av lärosätet: Uppsala universitet; Karolinska Institutet

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