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J Clin Endocrinol Metab. 2019 Sep 23. pii: dgz026. doi: 10.1210/clinem/dgz026. [Epub ahead of print]

Pioglitazone Exposure Reduced the Risk of All-Cause Mortality in Insulin-Treated Patients with Type 2 Diabetes Mellitus.

Yen FS1, Wang HC2,3, Pan CW4, Wei JC5, Hsu CC6,7,8, Hwu CM9,10.

Author information

1
Dr. Yen's Clinic, Shanying Road, Gueishan District, Taoyuan, Taiwan.
2
Management Office for Health Data, China Medical University Hospital, Hsueh-Shih Road, Taichung, Taiwan.
3
College of Medicine, China Medical University, Hsueh-Shih Road, Taichung, Taiwan.
4
University of the East Ramon Magsaysay Memorial Medical Centre, Inc., Quezon City, Philippines.
5
Division of Allergy, Immunology and Rheumatology Chung Shan Medical University Hospital, Jianguo North. Road, Taichung, Taiwan.
6
Institute of Population Health Sciences, National Health Research Institutes, Keyan Road, Zhunan, Miaoli County, Taiwan.
7
Department of Health Services Administration, China Medical University, Hsueh-Shih Road, Taichung, Taiwan.
8
Department of Family Medicine, Min-Sheng General Hospital,ChingKuo Road, Taoyuan, Taiwan.
9
Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
10
Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Shipai Road, Beitou District, Taipei, Taiwan.

Abstract

CONTEXT:

The long-term safety and benefit of pioglitazone use in combination with insulin are still uncertain.

OBJECTIVE:

This study compared the risks of all-cause mortality and major cardiovascular (CV) events between pioglitazone users and nonusers receiving insulin therapy.

DESIGN, SETTING AND PATIENTS:

We conducted a 13-year retrospective cohort study by using data from the population-based National Health Insurance Research Database in Taiwan. A total of 20,376 patients with type 2 diabetes mellitus (T2DM) receiving insulin therapy were enrolled during 2000-2012. Overall, the incidence rates of all-cause mortality and CV events were compared between 2579 pioglitazone users and 2579 matched nonusers.

RESULTS:

After adjustment for age, sex, comorbidities, Diabetes Complications Severity Index scores, and drugs used, mortality rates were 30.26 and 15.02 per 1000 person-years for pioglitazone nonusers and users, respectively. The adjusted hazard ratio (aHR) of mortality was 0.47 (95% confidence interval [CI]: 0.38-0.58, p < 0.001) for pioglitazone users compared with nonusers. The aHRs of CV and non-CV deaths were 0.78 (95% CI: 0.51-1.19) and 0.50 (95% CI: 0.38-0.66), respectively. The aHRs of hospitalized coronary artery disease, hospitalized stroke, and incident heart failure were not significantly different between pioglitazone users and nonusers.

CONCLUSIONS:

This nationwide cohort study demonstrated that pioglitazone use reduced the risks of all-cause mortality and non-CV death for patients with T2DM undergoing insulin therapy.

KEYWORDS:

cardiovascular death; mortality; non-cardiovascular death

PMID:
31544207
DOI:
10.1210/clinem/dgz026

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