Novel oral glucose-lowering drugs are associated with lower risk of all-cause mortality, cardiovascular events and severe hypoglycaemia compared with insulin in patients with type 2 diabetes - PubMed (original) (raw)

Observational Study

. 2017 Jun;19(6):831-841.

doi: 10.1111/dom.12889. Epub 2017 Mar 16.

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Observational Study

Novel oral glucose-lowering drugs are associated with lower risk of all-cause mortality, cardiovascular events and severe hypoglycaemia compared with insulin in patients with type 2 diabetes

Thomas Nyström et al. Diabetes Obes Metab. 2017 Jun.

Abstract

Aims: To investigate the association of novel oral glucose-lowering drugs (GLDs), compared with that of insulin, with risk of all-cause mortality, cardiovascular disease (CVD) and severe hypoglycaemia.

Methods: During 2013 to 2014 all patients with type 2 diabetes in Sweden identified as new users of novel oral GLDs, either dipeptidyl peptidase-4 (DPP-4) inhibitors or sodium-glucose cotransporter-2 (SGLT2) inhibitors (only dapagliflozin available in Sweden during the study period), with those initiating insulin as a comparison group, in the Prescribed Drug Register were included and followed in the Patient and Cause of Death Registers. The novel GLD group and insulin group were matched 1:1 using propensity score. Cox regression models were used to estimate risks.

Results: Of 37 603 patients, 21 758 were matched 1:1 to novel GLD vs insulin groups, with median follow-up times of 1.51 years (16 304 patient-years) and 1.53 years (16 306 patient-years), respectively. Treatment with novel GLDs was associated with a 44% (hazard ratio [HR] 0.56 [95% confidence interval {CI} 0.49-0.64]), 15% (HR 0.85 [95% CI 0.73-0.99]) and 74% (0.26 [95% CI 0.12-0.57]) lower risk of all-cause mortality, CVD and hypoglycaemia, respectively, compared with insulin treatment. In separate analyses for the two novel GLDs, dapagliflozin was associated with lower risks of all-cause mortality and CVD (56% [HR 0.44, 95% CI 0.28-0.70] and 49% [HR 0.51, 95% CI 0.30-0.86], respectively), while DPP-4 inhibitor treatment was associated with lower risk of all-cause mortality (41% [HR 0.59, 95% CI 0.51-0.67]), but not with CVD (HR 0.87, 95% CI 0.75-1.01).

Conclusions: Novel oral GLD treatment was associated with lower risk of all-cause mortality, CVD and severe hypoglycaemia compared with insulin treatment. Dapagliflozin was associated with a lower risk of both all-cause mortality and CVD, whereas DPP-4 inhibitor treatment was only associated with lower risk of all-cause mortality.

Keywords: DPP-4 inhibitor; cardiovascular disease; dapagliflozin; hypoglycaemia; pharmaco-epidemiology; type 2 diabetes.

© 2017 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

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Figures

Figure 1

Figure 1

Patient flow chart.

Figure 2

Figure 2

Kaplan–Meier curves and

HRs

comparing propensity score‐matched novel

GLD

and insulin groups for A, all‐cause mortality; B, fatal and non‐fatal

CVD

; and C, severe hypoglycaemia. [Correction added on 28th April, after first online publication: Supplied Figure 2 was previously incorrect and has been amended in this version]

Figure 3

Figure 3

Kaplan–Meier curves and

HRs

comparing propensity score‐matched dapagliflozin and

DPP

‐4 inhibitors vs insulin groups for A and B, all‐cause mortality; C and D, fatal and non‐fatal

CVD

; and E and F, severe hypoglycaemia.

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