A Comparison of Select Cardiovascular Outcomes by Antidiabetic Prescription Drug Classes Used to Treat Type 2 Diabetes Among Military Health System Beneficiaries, Fiscal Year 2003-2006

Abstract

Recent research suggests that there is an increased risk of cardiovascular outcomes among individuals with type 2 diabetes taking rosiglitazone (Avandia). To determine if there is an increased incidence of select cardiovascular events, specifically acute myocardial infarction (AMI) and congestive heart failure (CHF), among Military Health System beneficiaries with type 2 diabetes who filled a prescription for Avandia compared with those who filled prescriptions for other antidiabetic medications. Cross-sectional analysis of data from fiscal year 2003-2006. Military Health System beneficiaries who are enrolled in TRICARE Prime [Health Maintenance Organization (HMO)-like option] with a diagnosis of type 2 diabetes. Average annual incidence of AMI and CHF was lowest among individuals who filled a prescription for biguanides (metformin) and greatest among those who filled a prescription for insulin. The incidence of AMI was highest among beneficiaries with a triple combination of antidiabetic drugs including insulin. The incidence of CHF was highest among those who took a sulfonylurea and Actos during the observation period (fiscal year 2003-2006). This study has several limitations including the cross-sectional design and inability to make statistical comparisons across drug categories. There does not appear to be an increased annual incidence of AMI or CHF among TRICARE Prime beneficiaries with a diagnosis of type 2 diabetes who have filled a prescription for Avandia compared with those who filled prescriptions for other antidiabetic medications.