The association of the treatment with glucagon-like peptide-1 receptor agonist exenatide or insulin with cardiovascular outcomes in patients with type 2 diabetes: a retrospective observational study

Cardiovascular Diabetology

Jennie H Best²  David Maggs¹  Kerenaftali Klein⁴  Sanjoy K Paul³ 

[1] Bristol-Myers Squibb, San Diego, CA, USA;University of Washington, Seattle, WA, USA;Clinical Trials & Biostatistics Unit, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane, 4006, QLD, Australia;Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia

关键词: Pharmaco-epidemiology;    Type 2 diabetes;    Macrovascular outcomes;    Insulin;    Exenatide;   

Others  :  1118917
DOI  :  10.1186/s12933-015-0178-3

 received in 2014-11-13, accepted in 2015-01-09,  发布年份 2015

【 摘 要 】

Background

To evaluate the association of treatment with glucagon-like peptide-1 (GLP-1) receptor agonist exenatide and/or insulin on macrovascular outcomes in patients with type 2 diabetes (T2DM).

Methods

We conducted a retrospective longitudinal pharmaco-epidemiological study using large ambulatory care data to evaluate the risks of heart failure (HF), myocardial infarction (MI) and stroke in established T2DM patients who received a first prescription of exenatide twice daily (EBID) or insulin between June 2005 and May 2009, with follow-up data available until December 2012. Three treatment groups were: EBID with oral antidiabetes drugs (OADs) (EBID, n = 2804), insulin with OADs (Insulin, n = 28551), and those who changed medications between EBID and insulin or had combination of EBID and insulin during follow-up, along with OADs (EBID + insulin, n = 7870).

Multivariate Cox-regression models were used to evaluate the association of treatment groups with the risks of macrovascular events.

Results

During a median 3.5 years of follow-up, cardiovascular event rates per 1000 person-years were significantly lower for the EBID and EBID + insulin groups compared to the insulin group (HF: 4.4 and 6.1 vs. 17.9; MI: 1.1 and 1.2 vs. 2.5; stroke: 2.4 and 1.8 vs. 6.1). Patients in the EBID/EBID + insulin group had significantly reduced risk of HF, MI and stroke by 61/56%, 50/38% and 52/63% respectively, compared to patients in the insulin group (p < 0.01).

Conclusions

Treatment with exenatide, with or without concomitant insulin was associated with reduced macrovascular risks compared to insulin; although inherent potential bias in epidemiological studies should be considered.

【 授权许可】

   
2015 Paul et al.; licensee BioMed Central.

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