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Comparing kidney outcomes in type 2 diabetes treated with different sulphonylureas in real-life clinical practice

 Y.-h. Lee  ;  C.J. Lee  ;  H.S. Lee  ;  E.Y. Choe  ;  B.-W. Lee  ;  C.W. Ahn  ;  B.-S. Cha  ;  H.C. Lee  ;  B. Balkau  ;  E.S. Kang 
 DIABETES & METABOLISM, Vol.41(3) : 208-215, 2015 
Journal Title
Issue Date
Cohort Studies ; Creatinine/blood ; Diabetes Mellitus, Type 2*/complications ; Diabetes Mellitus, Type 2*/drug therapy ; Diabetes Mellitus, Type 2*/mortality ; Female ; Gliclazide/adverse effects* ; Gliclazide/therapeutic use ; Humans ; Hypoglycemic Agents/adverse effects* ; Hypoglycemic Agents/therapeutic use ; Kaplan-Meier Estimate ; Kidney Failure, Chronic*/chemically induced ; Kidney Failure, Chronic*/complications ; Kidney Failure, Chronic*/mortality ; Male ; Middle Aged ; Propensity Score ; Retrospective Studies ; Sulfonylurea Compounds/adverse effects* ; Sulfonylurea Compounds/therapeutic use
Chronic kidney disease ; Gliclazide ; Glimepiride ; Type 2 diabetes
AIM: Although several sulphonylureas are widely used in type 2 diabetes (T2D), their differential impacts on long-term major kidney outcomes remain unclear. This study aimed to investigate the effects of the two most commonly prescribed sulphonylureas, glimepiride and gliclazide, on kidney outcomes in patients with T2D.

METHODS: A total of 4486 patients treated with either glimepiride or gliclazide for more than 2 years were followed for up to 5.5 years (median: 4.7 years). A propensity score based on baseline characteristics was used to match 1427 patients treated with glimepiride with 1427 gliclazide-treated patients; incidences of end-stage renal disease (ESRD) and sustained doubling of creatinine to>132.6 μmol/L (1.5mg/dL) were also compared.

RESULTS: In the matched cohort with 12,122 person-years of follow-up, there was no significant difference between groups in risk of ESRD [hazard ratio (HR): 0.57, 95% confidence interval (CI): 0.29-1.12] or doubling of creatinine (HR: 0.74, 95% CI: 0.44-1.26), although there was a trend towards higher risks in the glimepiride group. Subgroup analyses showed that, compared with glimepiride, gliclazide was associated with a lower risk of doubling of creatinine in patients with preserved renal function (glomerular filtration rate ≥ 60 mL/min/1.73 m(2), HR: 0.21, 95% CI: 0.04-0.99) and good glycaemic control (HbA1c < 7%, HR: 0.35, 95% CI: 0.14-0.86), and in older subjects (≥ 62 years, HR: 0.52, 95% CI: 0.27-0.99).

CONCLUSION: In a real-life setting, there was no significant difference in clinical outcomes of kidney disease for patients treated with glimepiride vs gliclazide. However, gliclazide appeared to protect against renal complication progression in certain populations.
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6. Others (기타) > Dept. of Health Promotion (건강의학과) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kang, Eun Seok(강은석) ORCID logo https://orcid.org/0000-0002-0364-4675
Ahn, Chul Woo(안철우) ORCID logo https://orcid.org/0000-0003-3733-7486
Lee, Byung Wan(이병완) ORCID logo https://orcid.org/0000-0002-9899-4992
Lee, Yong Ho(이용호) ORCID logo https://orcid.org/0000-0002-6219-4942
Lee, Chan Joo(이찬주) ORCID logo https://orcid.org/0000-0002-8756-409X
Lee, Hyun Chul(이현철)
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Cha, Bong Soo(차봉수) ORCID logo https://orcid.org/0000-0003-0542-2854
Choe, Eun Yeong(최은영)
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