Effects on clinical outcomes of intensifying triple oral antidiabetic drug (OAD) therapy by initiating insulin versus enhancing OAD therapy in patients with type 2 diabetes: A nationwide population-based, propensity-score-matched cohort study.
Administration, Oral
Adult
Aged
Cohort Studies
Diabetes Mellitus, Type 2
/ blood
Diabetic Angiopathies
/ epidemiology
Dose-Response Relationship, Drug
Drug Therapy, Combination
/ methods
Female
Humans
Hypoglycemic Agents
/ administration & dosage
Insulin
/ therapeutic use
Male
Middle Aged
Propensity Score
Retrospective Studies
Taiwan
/ epidemiology
Treatment Failure
Treatment Outcome
antidiabetic drug
cardiovascular disease
cohort study
hypoglycaemia
insulin therapy
type 2 diabetes
Journal
Diabetes, obesity & metabolism
ISSN: 1463-1326
Titre abrégé: Diabetes Obes Metab
Pays: England
ID NLM: 100883645
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
24
05
2018
revised:
20
08
2018
accepted:
01
09
2018
pubmed:
7
9
2018
medline:
10
9
2019
entrez:
7
9
2018
Statut:
ppublish
Résumé
To compare the effects of initiating insulin as a fourth-line antidiabetic therapy with the effects of enhancing oral antidiabetic drug (OAD) therapy in patients with type 2 diabetes mellitus (T2DM) with triple OAD therapy failure. We conducted a nationwide population-based, retrospective cohort study involving 1022 (without prevalent diabetes-related complications [PDRCs]) and 2077 (with/without PDRCs) propensity score-matched pairs of fourth-line insulin therapy users and enhanced OAD therapy users identified in the period 2004 to 2010. Clinical outcomes including a composite cardiovascular outcome (myocardial infarction, stroke, heart failure or ischaemic heart disease), peripheral vascular disease (PVD), hypoglycaemia and all-cause mortality were assessed up to 2013. Hypoglycaemia was adjusted in Cox models to consider its potential effect on study outcomes. In a T2DM cohort without PDRCs, fourth-line insulin therapy was not associated with greater risks of clinical outcomes, except hypoglycaemia (hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.02-2.07), compared with enhanced OAD therapy. Among patients with T2DM with/without PDRCs, fourth-line insulin therapy was associated with greater risks of the composite cardiovascular outcome (HR 1.23, 95% CI 1.03-1.46), heart failure (HR 1.59, 95% CI 1.12-2.25), ischaemic heart disease (HR 1.37, 95% CI 1.09-1.73), PVD (HR 1.17, 95% CI 1.00-1.36), hypoglycaemia (HR 1.49, 95% CI 1.20-1.85) and all-cause mortality (HR 1.48, 95% CI 1.01-2.17), but adjustment for hypoglycaemia significantly attenuated the risk of heart failure (HR 1.34, 95% CI 0.92-1.94), PVD (HR 1.15, 95% CI 0.98-1.34) and all-cause mortality (HR 1.30, 95% CI 0.84-1.99). Initiation of fourth-line insulin therapy can be considered for patients with T2DM with triple OAD therapy failure, and the importance of awareness and prevention of hypoglycaemia among insulin-treated patients with T2DM cannot be overstated.
Identifiants
pubmed: 30187666
doi: 10.1111/dom.13525
pmc: PMC6329671
mid: NIHMS988644
doi:
Substances chimiques
Hypoglycemic Agents
0
Insulin
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
312-320Subventions
Organisme : NIDDK NIH HHS
ID : P30 DK092926
Pays : United States
Informations de copyright
© 2018 John Wiley & Sons Ltd.
Références
Pharmacoepidemiol Drug Saf. 2011 Mar;20(3):236-42
pubmed: 21351304
Circulation. 2009 Dec 22;120(25):2529-40
pubmed: 19920001
Diabetes Care. 2018 Aug;41(8):1783-1791
pubmed: 29903847
Lancet. 2008 May 24;371(9626):1753-60
pubmed: 18502299
Cochrane Database Syst Rev. 2007 Apr 18;(2):CD005613
pubmed: 17443605
J Investig Med. 2007 Mar;55(2):62-8
pubmed: 17362692
Diabetes Res Clin Pract. 2016 Nov;121:69-85
pubmed: 27662041
Eur Heart J. 2013 Oct;34(40):3137-44
pubmed: 23999452
Diabetes Care. 2010 Apr;33(4):733-5
pubmed: 20086256
Diab Vasc Dis Res. 2017 Jul;14(4):295-303
pubmed: 28330386
JAMA. 2014 Jun 11;311(22):2288-96
pubmed: 24915260
Diabetes Care. 2013 Nov;36(11):3411-7
pubmed: 23877982
N Engl J Med. 2010 Oct 7;363(15):1410-8
pubmed: 20925543
Br J Clin Pharmacol. 2017 Jul;83(7):1556-1570
pubmed: 28109184
Medicine (Baltimore). 2016 Jun;95(26):e3995
pubmed: 27368005
Diabetes Obes Metab. 2016 Feb;18(2):152-8
pubmed: 26511332
Diabetes Res Clin Pract. 2017 Jan;123:199-208
pubmed: 28056431
JAMA. 2016 Jul 19;316(3):313-24
pubmed: 27434443
BMJ. 2013 Jul 29;347:f4533
pubmed: 23900314
J Am Heart Assoc. 2017 Jul 21;6(7):
pubmed: 28733435
Diabetes Care. 2017 Jan;40(Suppl 1):S64-S74
pubmed: 27979895
Diabetes Metab J. 2016 Jun;40(3):202-10
pubmed: 27098504
Int J Cardiol. 2015 Dec 15;201:96-101
pubmed: 26292275
J Formos Med Assoc. 2005 Mar;104(3):157-63
pubmed: 15818428
J Gen Intern Med. 2007 Dec;22 Suppl 3:408-18
pubmed: 18026810
Int J Cardiol. 2016 Jul 15;215:277-82
pubmed: 27128546
N Engl J Med. 2012 Jul 26;367(4):319-28
pubmed: 22686416
PLoS One. 2014 Dec 02;9(12):e112257
pubmed: 25464005
Am J Manag Care. 2012 Nov;18(11):721-6
pubmed: 23198714
Diabetes Obes Metab. 2013 Oct;15(10):938-53
pubmed: 23594109
Prim Care Diabetes. 2015 Apr;9(2):135-41
pubmed: 25266893
J Am Heart Assoc. 2016 Mar 09;5(3):e002875
pubmed: 26961698
Diabetes Care. 2018 Jan;41(1):104-111
pubmed: 29127240
Diabetes Care. 2012 Jul;35(7):1406-12
pubmed: 22723578
Diabetologia. 2011 Jun;54(6):1308-17
pubmed: 21359582
Atherosclerosis. 2014 Jan;232(1):224-30
pubmed: 24401243
Health Aff (Millwood). 2003 May-Jun;22(3):61-76
pubmed: 12757273
J Clin Endocrinol Metab. 2013 Feb;98(2):668-77
pubmed: 23372169
J Epidemiol. 2014;24(6):500-7
pubmed: 25174915
Diabetes Obes Metab. 2016 Oct;18(10):990-8
pubmed: 27282621
Prim Care Diabetes. 2010 Apr;4 Suppl 1:S11-8
pubmed: 20394886
Diabetes Res Clin Pract. 2008 Aug;81(2):184-9
pubmed: 18495286
BMC Endocr Disord. 2008 Apr 01;8:4
pubmed: 18380903
Diabetes Care. 2018 Mar;41(3):596-603
pubmed: 29311155
N Engl J Med. 2008 Oct 9;359(15):1577-89
pubmed: 18784090
Heart. 2016 Oct 1;102(19):1581-7
pubmed: 27217068
BMJ. 2016 Jul 12;354:i3477
pubmed: 27413012