Abstract
AimTo compare the risks of hospitalization for heart failure (HHF) associated with sulfonylurea (SU), dipeptidyl peptidase-4 inhibitor (DPP-4i), and thiazolidinedione (TZD) as add-on medications to metformin (MET) therapy using the data of Korean adults with type-2 diabetes from the Korean National Health Insurance database.MethodsWe identified 98,383 people who received SU (n = 42,683), DPP-4i (n = 50,310), or TZD (n = 5,390) added to initial treatment of MET monotherapy in patients with type-2 diabetes. The main outcome was the hospitalization for HHF. Hazard ratios for HHF by type of second-line glucose-lowering medication were estimated by Cox-proportional hazard models. Sex, age, duration of MET monotherapy, Charlson Comorbidity Index and additional comorbidities, and calendar year were controlled as potential confounders.ResultsThe observed numbers (rate per 100,000 person-years) of HHF events were 1,129 (658) for MET+SU users, 710 (455) for MET+DPP-4i users, and 110 (570) for MET+TZD users. Compared to that for MET+SU users (reference group), the adjusted hazard ratios for HHF events were 0.76 (95% confidence interval 0.69–0.84) for MET+DPP-4i users and 0.96 (95% confidence interval 0.79–1.17) for MET+TZD users.ConclusionDPP-4i as an add-on therapy to MET may lower the risks of HHF compared with SU.
Highlights
Heart failure (HF) is one of the main health burdens of cardiovascular disease (CVD) in people with type-2 diabetes mellitus (T2D) [1]
As second-line therapies added to MET, sulfonylurea (SU), dipeptidyl peptidase-4 inhibitor (DPP-4i), and thiazolidinedione (TZD) have been most frequently prescribed in Korea according to data from the Korean Diabetes Association [4]
Compared with use of MET+SU, the use of MET+DPP-4i was associated with an 18% lower rate of hospitalization for heart failure (HHF) in the group with a history of CVD (HR 0.82, 95% confidence intervals (CIs) 0.70–0.96) and a 28% lower rate of HHF in the group without a history of CVD (HR 0.72; 95% CI 0.63–0.82)
Summary
Heart failure (HF) is one of the main health burdens of cardiovascular disease (CVD) in people with type-2 diabetes mellitus (T2D) [1]. Metformin (MET) is the most commonly used starting drug for patients with T2D on the basis of international guidelines [3]. In Korea, MET is the preferred initial oral antidiabetic drug, and it has been the most commonly prescribed antidiabetic medication since 2010 [4, 5]. In 2016, >80% of dual therapy regimens included MET as the first-line therapy. As second-line therapies added to MET, sulfonylurea (SU), dipeptidyl peptidase-4 inhibitor (DPP-4i), and thiazolidinedione (TZD) have been most frequently prescribed in Korea according to data from the Korean Diabetes Association [4]. MET+SU was the most common dual therapy protocol until 2014. At present, MET+DPP-4i is the most frequently prescribed dual therapy
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