Association of Hemoglobin A1c Levels With Use of Sulfonylureas, Dipeptidyl Peptidase 4 Inhibitors, and Thiazolidinediones in Patients With Type 2 Diabetes Treated With Metformin
| العنوان: | Association of Hemoglobin A1c Levels With Use of Sulfonylureas, Dipeptidyl Peptidase 4 Inhibitors, and Thiazolidinediones in Patients With Type 2 Diabetes Treated With Metformin |
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| المؤلفون: | Alison Callahan, Alejandro Schuler, Nigam H. Shah, Juan M. Banda, Anthony Reckard, Rohit Vashisht, Christian G. Reich, George Hripcsak, Martijn J. Schuemie, James Weaver, Mark M. Shervey, Mui Van Zandt, Sanghyung Jin, Joel T. Dudley, Yonghui Wu, Kenneth Jung, Peng Jin, Rae Woong Park, Karthik Natrajan, Kipp W. Johnson, Hua Xu, Patrick B. Ryan, Li Li |
| المصدر: | JAMA Network Open |
| بيانات النشر: | American Medical Association (AMA), 2018. |
| سنة النشر: | 2018 |
| مصطلحات موضوعية: | Male, medicine.medical_specialty, endocrine system diseases, Type 2 diabetes, 01 natural sciences, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, Internal medicine, Humans, Hypoglycemic Agents, Medicine, 030212 general & internal medicine, 0101 mathematics, Medical prescription, Original Investigation, Glycated Hemoglobin, Dipeptidyl-Peptidase IV Inhibitors, business.industry, Research, 010102 general mathematics, Hazard ratio, nutritional and metabolic diseases, General Medicine, medicine.disease, Metformin, 3. Good health, Online Only, Diabetes and Endocrinology, Sulfonylurea Compounds, Hemoglobin A, Diabetes Mellitus, Type 2, Eye disorder, Female, Thiazolidinediones, Kidney disorder, business, medicine.drug |
| الوصف: | Key Points Question Can the effectiveness of second-line treatment of type 2 diabetes after initial therapy with metformin be characterized via an open collaborative research network? Findings In this analysis of data from more than 246 million patients in multiple cohorts, treatment with dipeptidyl peptidase 4 inhibitors compared with sulfonylureas and thiazolidinediones did not differ in reducing hemoglobin A1c levels or hazard of kidney disorders. In a meta-analysis, sulfonylureas compared with dipeptidyl peptidase 4 inhibitors were associated with a small increased hazard of myocardial infarction and eye disorders in patients with type 2 diabetes. Meaning Large-scale characterization of the effectiveness of type 2 diabetes therapy across nations through an open collaborative research network aligns with the 2017 recommendation of the American Association of Clinical Endocrinologists and American College of Endocrinology in type 2 diabetes management recommending dipeptidyl peptidase 4 inhibitors over sulfonylureas in patients with diabetes for whom metformin was the first-line treatment. Importance Consensus around an efficient second-line treatment option for type 2 diabetes (T2D) remains ambiguous. The availability of electronic medical records and insurance claims data, which capture routine medical practice, accessed via the Observational Health Data Sciences and Informatics network presents an opportunity to generate evidence for the effectiveness of second-line treatments. Objective To identify which drug classes among sulfonylureas, dipeptidyl peptidase 4 (DPP-4) inhibitors, and thiazolidinediones are associated with reduced hemoglobin A1c (HbA1c) levels and lower risk of myocardial infarction, kidney disorders, and eye disorders in patients with T2D treated with metformin as a first-line therapy. Design, Setting, and Participants Three retrospective, propensity-matched, new-user cohort studies with replication across 8 sites were performed from 1975 to 2017. Medical data of 246 558 805 patients from multiple countries from the Observational Health Data Sciences and Informatics (OHDSI) initiative were included and medical data sets were transformed into a unified common data model, with analysis done using open-source analytical tools. Participants included patients with T2D receiving metformin with at least 1 prior HbA1c laboratory test who were then prescribed either sulfonylureas, DPP-4 inhibitors, or thiazolidinediones. Data analysis was conducted from 2015 to 2018. Exposures Treatment with sulfonylureas, DPP-4 inhibitors, or thiazolidinediones starting at least 90 days after the initial prescription of metformin. Main Outcomes and Measures The primary outcome is the first observation of the reduction of HbA1c level to 7% of total hemoglobin or less after prescription of a second-line drug. Secondary outcomes are myocardial infarction, kidney disorder, and eye disorder after prescription of a second-line drug. Results A total of 246 558 805 patients (126 977 785 women [51.5%]) were analyzed. Effectiveness of sulfonylureas, DPP-4 inhibitors, and thiazolidinediones prescribed after metformin to lower HbA1c level to 7% or less of total hemoglobin remained indistinguishable in patients with T2D. Patients treated with sulfonylureas compared with DPP-4 inhibitors had a small increased consensus hazard ratio of myocardial infarction (1.12; 95% CI, 1.02-1.24) and eye disorders (1.15; 95% CI, 1.11-1.19) in the meta-analysis. Hazard of observing kidney disorders after treatment with sulfonylureas, DPP-4 inhibitors, or thiazolidinediones was equally likely. Conclusions and Relevance The examined drug classes did not differ in lowering HbA1c and in hazards of kidney disorders in patients with T2D treated with metformin as a first-line therapy. Sulfonylureas had a small, higher observed hazard of myocardial infarction and eye disorders compared with DPP-4 inhibitors in the meta-analysis. The OHDSI collaborative network can be used to conduct a large international study examining the effectiveness of second-line treatment choices made in clinical management of T2D. This multinational cohort study examines the association of second-line treatment (sulfonylureas, dipeptidyl peptidase 4 inhibitors [DPP-4], or thiazolidinediones) for type 2 diabetes after initial therapy with metformin with hemoglobin A1c (HbA1c) levels. |
| تدمد: | 2574-3805 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::34c8657a2b522d5da75897fefe16d8b2 https://doi.org/10.1001/jamanetworkopen.2018.1755 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....34c8657a2b522d5da75897fefe16d8b2 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 25743805 |
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