Recent metformin adherence and the risk of hypoglycaemia in the year following intensification with a sulfonylurea.
Aged
Cohort Studies
Diabetes Mellitus, Type 2
/ drug therapy
Dose-Response Relationship, Drug
Drug Therapy, Combination
Female
Glycated Hemoglobin
/ drug effects
Humans
Hypoglycemia
/ chemically induced
Hypoglycemic Agents
/ administration & dosage
Male
Medication Adherence
/ statistics & numerical data
Metformin
/ administration & dosage
Middle Aged
Retrospective Studies
Risk Factors
Sulfonylurea Compounds
/ administration & dosage
Time Factors
Veterans
/ statistics & numerical data
Journal
Diabetic medicine : a journal of the British Diabetic Association
ISSN: 1464-5491
Titre abrégé: Diabet Med
Pays: England
ID NLM: 8500858
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
accepted:
29
10
2018
pubmed:
1
11
2018
medline:
6
2
2020
entrez:
1
11
2018
Statut:
ppublish
Résumé
To evaluate whether recent low adherence to metformin monotherapy is associated with hypoglycaemia after addition of a sulfonylurea. We assembled a retrospective cohort of veterans who filled a new prescription for metformin between 2001 and 2011 and intensified treatment with a sulfonylurea after ≥1 year of metformin use. We calculated metformin adherence from pharmacy data using the proportion of days covered in the 180-day period before intensification. The primary outcome was hypoglycaemia, defined as a hospitalization or emergency department visit for hypoglycaemia or an outpatient blood glucose measurement <3.3 mmol/l in the year following intensification. Cox proportional hazards models were used to compare the risk of hypoglycaemia between participants with low (<80%) and high (≥80%) adherence. Adherence was also modelled as a continuous variable using restricted cubic splines. Of 187 267 participants who initiated metformin monotherapy, 49 424 added a sulfonylurea after ≥1 year. The median (interquartile range) rate of treatment adherence was 87 (50-100)% and 43% had adherence <80%. Hypoglycaemia rates per 1000 person-years were 23.1 (95% CI 21.1-25.4) and 24.5 (95% CI 22.7-26.4) in participants with low and high adherence, respectively (adjusted hazard ratio 0.95, 95% CI 0.84-1.08). The risk of hypoglycaemia was similar across all levels of adherence when adherence was modelled as a continuous variable. We found no evidence that past low adherence to metformin monotherapy was associated with hypoglycaemia after intensification with a sulfonylurea.
Identifiants
pubmed: 30378161
doi: 10.1111/dme.13853
pmc: PMC7121933
mid: NIHMS1066557
doi:
Substances chimiques
Glycated Hemoglobin A
0
Hypoglycemic Agents
0
Sulfonylurea Compounds
0
Metformin
9100L32L2N
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
482-490Subventions
Organisme : CSRD VA
ID : I01 CX000570
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK020593
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK092986
Pays : United States
Organisme : NCATS NIH HHS
ID : TL1 TR000447
Pays : United States
Informations de copyright
Published 2018. This article is a U.S. Government work and is in the public domain in the USA.
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