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Cardiovascular events associated with second-line anti-diabetes treatments: analysis of real-world Korean data

 K. H. Ha  ;  B. Kim  ;  H. Choi  ;  D. J. Kim  ;  H. C. Kim 
 DIABETIC MEDICINE, Vol.34(9) : 1235-1243, 2017 
Journal Title
Issue Date
Adult ; Aged ; Cardiovascular Diseases/epidemiology* ; Diabetes Mellitus, Type 2/drug therapy* ; Diabetes Mellitus, Type 2/epidemiology* ; Dipeptidyl-Peptidase IV Inhibitors/therapeutic use ; Drug Therapy, Combination/classification ; Drug Therapy, Combination/statistics & numerical data ; Female ; Humans ; Hypoglycemic Agents/classification* ; Hypoglycemic Agents/therapeutic use* ; Male ; Metformin/therapeutic use ; Middle Aged ; Republic of Korea/epidemiology ; Risk Factors ; Sulfonylurea Compounds/therapeutic use ; Survival Analysis ; Thiazolidinediones/therapeutic use ; Time Factors ; Treatment Outcome
AIM: To compare the risks of cardiovascular disease (CVD) and all-cause mortality associated with sulfonylurea (SU), dipeptidyl peptidase-4 inhibitor (DPP4i) and thiazolidinedione (TZD) as add-on medications to metformin (MET) therapy in people with Type 2 diabetes. METHODS: We identified 40 263 individuals who used SU (n = 11 582), DPP4i (n = 26 623) or TZD (n = 2058) in addition to MET between January 2013 and June 2015 from the database of the Korean National Health Insurance, the single-payer healthcare system in South Korea. Cox proportional hazard models were used to estimate hazard ratios for major CVD event (coronary artery disease, heart failure, stroke or transient ischaemic attack) development and all-cause mortality by second-line anti-diabetes medication type. Age, sex, duration of MET monotherapy, calendar year and comorbid conditions were adjusted as potential confounders. RESULTS: The observed numbers of CVD events (total observed person-time) were 485 (18 778 person-years) for MET + SU, 744 (40 374 person-years) for MET + DPP4i and 60 (3014 person-years) for MET + TZD users. Compared with MET + SU users, the fully adjusted hazard ratios for CVD events were 0.79 [95% confidence interval (CI): 0.71-0.89] for MET + DPP4i users and 0.85 (95% CI: 0.65-1.11) for MET + TZD users. The corresponding hazard ratios for all-cause mortality were 0.84 (95% CI: 0.66-1.07) for MET + DPP4i users and 0.67 (95% CI: 0.35-1.28) for MET + TZD users. CONCLUSION: Analysis of Korea National Health Insurance database showed that MET + DPP4i treatment for diabetes had a lower CVD risk than MET + SU treatment.
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1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyeon Chang(김현창) ORCID logo https://orcid.org/0000-0001-7867-1240
Choi, Han Sol(최한솔)
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