PMID- 27413012
OWN - NLM
STAT- MEDLINE
DCOM- 20170322
LR  - 20170817
IS  - 1756-1833 (Electronic)
IS  - 0959-8138 (Linking)
VI  - 354
DP  - 2016 Jul 12
TI  - Diabetes treatments and risk of heart failure, cardiovascular disease, and all
      cause mortality: cohort study in primary care.
PG  - i3477
LID - 10.1136/bmj.i3477 [doi]
AB  - OBJECTIVE: To assess associations between risks of cardiovascular disease, heart 
      failure, and all cause mortality and different diabetes drugs in people with type
      2 diabetes, particularly newer agents, including gliptins and thiazolidinediones 
      (glitazones). DESIGN: Open cohort study. SETTING: 1243 general practices
      contributing data to the QResearch database in England. PARTICIPANTS: 469 688
      people with type 2 diabetes aged 25-84 years between 1 April 2007 and 31 January 
      2015. EXPOSURES: Diabetes drugs (glitazones, gliptins, metformin, sulphonylureas,
      insulin, other) alone and in combination. MAIN OUTCOME MEASURE: First recorded
      diagnoses of cardiovascular disease, heart failure, and all cause mortality
      recorded on the patients' primary care, mortality, or hospital record. Cox
      proportional hazards models were used to estimate hazard ratios for diabetes
      treatments, adjusting for potential confounders. RESULTS: During follow-up, 21
      308 patients (4.5%) received prescriptions for glitazones and 32 533 (6.9%)
      received prescriptions for gliptins. Compared with non-use, gliptins were
      significantly associated with an 18% decreased risk of all cause mortality, a 14%
      decreased risk of heart failure, and no significant change in risk of
      cardiovascular disease; corresponding values for glitazones were significantly
      decreased risks of 23% for all cause mortality, 26% for heart failure, and 25%
      for cardiovascular disease. Compared with no current treatment, there were no
      significant associations between monotherapy with gliptins and risk of any
      complications. Dual treatment with gliptins and metformin was associated with a
      decreased risk of all three outcomes (reductions of 38% for heart failure, 33%
      for cardiovascular disease, and 48% for all cause mortality). Triple treatment
      with metformin, sulphonylureas, and gliptins was associated with a decreased risk
      of all three outcomes (reductions of 40% for heart failure, 30% for
      cardiovascular disease, and 51% for all cause mortality). Compared with no
      current treatment, monotherapy with glitazone was associated with a 50% decreased
      risk of heart failure, and dual treatment with glitazones and metformin was
      associated with a decreased risk of all three outcomes (reductions of 50% for
      heart failure, 54% for cardiovascular disease, and 45% for all cause mortality); 
      dual treatment with glitazones and sulphonylureas was associated with risk
      reductions of 35% for heart failure and 25% for cardiovascular disease; triple
      treatment with metformin, sulphonylureas, and glitazones was associated with
      decreased risks of all three outcomes (reductions of 46% for heart failure, 41%
      for cardiovascular disease, and 56% for all cause mortality). CONCLUSIONS: There 
      are clinically important differences in risk of cardiovascular disease, heart
      failure, and all cause mortality between different diabetes drugs alone and in
      combination. Overall, use of gliptins or glitazones was associated with decreased
      risks of heart failure, cardiovascular disease, and all cause mortality compared 
      with non-use of these drugs. These results, which do not account for levels of
      adherence or dosage information and which are subject to confounding by
      indication, might have implications for prescribing of diabetes drugs.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not
      already granted under a licence) please go to
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - Hippisley-Cox, Julia
AU  - Hippisley-Cox J
AD  - Division of Primary Care, University Park, University of Nottingham, Nottingham
      NG2 7RD, UK Julia.hippisley-cox@nottingham.ac.uk.
FAU - Coupland, Carol
AU  - Coupland C
AD  - Division of Primary Care, University Park, University of Nottingham, Nottingham
      NG2 7RD, UK.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20160712
PL  - England
TA  - BMJ
JT  - BMJ (Clinical research ed.)
JID - 8900488
RN  - 0 (Dipeptidyl-Peptidase IV Inhibitors)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 0 (Sulfonylurea Compounds)
RN  - 0 (Thiazolidinediones)
RN  - 9100L32L2N (Metformin)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiovascular Diseases/*epidemiology
MH  - Cause of Death
MH  - Cohort Studies
MH  - Databases, Factual
MH  - Diabetes Mellitus, Type 2/*drug therapy/*epidemiology
MH  - Dipeptidyl-Peptidase IV Inhibitors/therapeutic use
MH  - Drug Therapy, Combination
MH  - England
MH  - Female
MH  - Heart Failure/*epidemiology
MH  - Humans
MH  - Hypoglycemic Agents/therapeutic use
MH  - Insulin/therapeutic use
MH  - Male
MH  - Metformin/therapeutic use
MH  - Middle Aged
MH  - *Mortality
MH  - Primary Health Care
MH  - Proportional Hazards Models
MH  - Risk Factors
MH  - Sulfonylurea Compounds/therapeutic use
MH  - Thiazolidinediones/therapeutic use
MH  - Treatment Outcome
PMC - PMC4948032
EDAT- 2016/07/15 06:00
MHDA- 2017/03/23 06:00
CRDT- 2016/07/15 06:00
PHST- 2016/07/15 06:00 [entrez]
PHST- 2016/07/15 06:00 [pubmed]
PHST- 2017/03/23 06:00 [medline]
PST - epublish
SO  - BMJ. 2016 Jul 12;354:i3477.