Glitazones and alpha-glucosidase inhibitors as the second-line oral anti-diabetic agents added to metformin reduce cardiovascular risk in Type 2 diabetes patients: a nationwide cohort observational study

Cardiovascular Diabetology

Chu-Leng Yu¹  Jin-Long Huang¹  Cheng-Hung Li¹  Tsu-Juey Wu¹  Ying-Chieh Liao¹  Cheng-Wei Chan¹  Yu-Cheng Hsieh¹  Jiunn-Cherng Lin¹  Chu-Pin Lo²  Chen-Ying Hung³  Ching-Heng Lin⁴  Che-Chen Lin⁴ 

[1] Cardiovascular Center, Taichung Veterans General Hospital;Department of Financial and Computational Mathematics, Providence University;Department of Internal Medicine, Hsinchu Branch, Taipei Veterans General Hospital;Department of Medical Research, Taichung Veterans General Hospital;

关键词: Anti-diabetic agent;    Cardiovascular risk;    Metformin;    Type 2 diabetes;   

DOI  :  10.1186/s12933-018-0663-6

来源: DOAJ

【 摘 要 】

Abstract Objective Metformin is the standard first-line drug for patients with Type 2 diabetes (T2DM). However, the optimal second-line oral anti-diabetic agent (ADA) remains unclear. We investigated the cardiovascular risk of various ADAs used as add-on medication to metformin in T2DM patients from a nationwide cohort. Methods T2DM patients using different add-on oral ADAs after an initial metformin therapy of > 90 days were identified from the Taiwan National Health Insurance Database. Five classes of ADAs, including sulphonylureas (SU), glinides, thiazolidinediones (TZD), alpha-glucosidase inhibitors (AGI), and dipeptidyl peptidase-4 inhibitors (DPP-4I) were selected for analysis. The reference group was the SU added to metformin. Patients were excluded if aged < 20 years, had a history of stroke or acute coronary syndrome (ACS), or were receiving insulin treatment. The primary outcomes included any major adverse cardiovascular event (MACE) including ACS, ischemic/hemorrhagic stroke, and death. A Cox regression model was used to estimate the hazard ratio (HR) for MACE. Results A total of 26,742 patients receiving their add-on drug to metformin of either SU (n = 24,277), glinides (n = 962), TZD (n = 581), AGI (n = 808), or DPP-4I (n = 114) were analyzed. After a mean follow-up duration of 6.6 ± 3.4 years, a total of 4775 MACEs occurred. Compared with the SU+metformin group (reference), the TZD+metformin (adjusted HR: 0.66; 95% CI 0.50–0.88, p = 0.004) and AGI+metformin (adjusted HR: 0.74; 95% CI 0.59–0.94, p = 0.01) groups showed a significantly lower risk of MACE. Conclusion Both TZD and AGI, when used as an add-on drug to metformin were associated with lower MACE risk when compared with SU added to metformin in this retrospective cohort study. Trial registration CE13152B-3. Registered 7 Mar, 2013, retrospectively registered

【 授权许可】

Unknown