Reduced vascular events in type 2 diabetes by biguanide relative to sulfonylurea: study in a Japanese Hospital Database - PubMed (original) (raw)

Observational Study

Reduced vascular events in type 2 diabetes by biguanide relative to sulfonylurea: study in a Japanese Hospital Database

Makito Tanabe et al. BMC Endocr Disord. 2015.

Abstract

Background: Some oral hypoglycemic agents (OHAs) have been suggested to reduce the risk of cardiovascular disease (CVD) in type-2 diabetes mellitus (T2DM). We ascertained if OHAs affect CVD risk in a cohort analysis of a multicenter medical-cost accounting database in Japan.

Methods: Data of 4095 and 1273 T2DM patients in study 1 and study 2, respectively, were extracted from the database based on the following conditions: (i) began treatment with a single OHA (sulfonylurea, biguanide, thiazolidinedione, α-glucosidase inhibitor, glinide, or dipeptidyl peptidase-4 inhibitor) and continued the medication for ~1-1.4 years; (ii) hemoglobin (Hb)A1c level at baseline was available; (iii) age at baseline was 40-70 years; (iv) presence or absence of CVD history was not considered in study 1, but presence of CVD history was considered in study 2. Effects of OHAs relative to sulfonylurea on CVD risk according to ICD-10 were analysed using Kaplan-Meier curves during 104 weeks.

Results: In study 1 targeting T2DM patients with and without a history of CVD, initial and baseline treatment with a biguanide significantly lowered the risk of CVD compared with that with a sulfonylurea, and was independent of HbA1c control. In study 2, a similar significant preventive effect of a biguanide on CVD risk relative to a sulfonylurea was observed in T2DM patients with history of CVD.

Conclusions: Initial treatment and baseline treatment with a biguanide can reduce CVD risk relative to a sulfonylurea independent of the blood glucose-lowering effect of the biguanide in Japanese T2DM patients.

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Figures

Fig. 1

Fig. 1

Outline and flowchart of the protocol for patient selection for analyses of cardiovascular events in study 1

Fig. 2

Fig. 2

Outline and flowchart of the protocol for patient selection for analyses of cardiovascular events in study 2

Fig. 3

Fig. 3

Kaplan-Meier curve for cardiovascular events during 104 weeks in patients with T2DM with or without a history of cardiovascular events. Number of patients in each drug group is listed in Table 1. Numbers of those in which 104-week follow-up was completed were 629 in SU, 1305 in biguanide, 592 in α-GI, 351 in TZD, 223 in glinide, and 995 in DPP-4 inhibitor groups, respectively (Table 1). Numbers of those in which a cardiovascular event was observed were 80 in SU, 84 in biguanide, 63 in α-GI, 35 in TZD, 21 in glinide, and 87 in DPP-4 inhibitor groups, respectively (Table 3A). Statistical comparison of cardiovascular events during 104 weeks in patients with T2DM with a history of cardiovascular events is shown in the inserted small table. Hazard ratio, Cox proportional hazard model adjusted by sex, age, HbA1c value (NGSP), use or non-use of anti-hypertensive drugs, use or non-use of anti-dyslipidemia drugs. CI indicates a 95 % confidence interval. **P < 0.01

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References

    1. de Marco R, Locatelli F, Zoppini G, Verlato G, Bonora E, Muggeo M. Cause-specific mortality in type 2 diabetes. The Verona Diabetes Study. Diabetes Care. 1999;22:756–761. doi: 10.2337/diacare.22.5.756. - DOI - PubMed
    1. Haffner S, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229–234. doi: 10.1056/NEJM199807233390404. - DOI - PubMed
    1. Fujishima M, Kiyohara Y, Kato I, Ohmura T, Iwamoto H, Nakayama K, Ohmori S, Yoshitake T. Diabetes and cardiovascular disease in a prospective population survey in Japan: The Hisayama Study. Diabetes. 1996;45(Suppl. 3):S14–S16. doi: 10.2337/diab.45.3.S14. - DOI - PubMed
    1. Mukamal KJ, Nesto RW, Cohen MC, Muller JE, Maclure M, Sherwood JB, Mittleman MA. Impact of diabetes on long-term survival after acute myocardial infarction: comparability of risk with prior myocardial infarction. Diabetes Care. 2001;24:1422–1427. doi: 10.2337/diacare.24.8.1422. - DOI - PubMed
    1. Roumie CL, Hung AM, Greevy RA, Grijalva CG, Liu X, Murff HJ, Elasy TA, Griffin MR. Comparative effectiveness of sulfonylurea and metformin monotherapy on cardiovascular events in type 2 diabetes mellitus: a cohort study. Ann Intern Med. 2012;157:601–610. doi: 10.7326/0003-4819-157-9-201211060-00003. - DOI - PMC - PubMed

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