Chia-Jen Shih1, Hung-Ta Chen2, Shu-Chen Kuo3, Shuo-Ming Ou4, Yung-Tai Chen5. 1. School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan. 2. School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan. 3. School of Medicine, National Yang-Ming University, Taipei, Taiwan; National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan; Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan. 4. School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: okokyytt@gmail.com. 5. School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Nephrology, Department of Medicine, Taipei City Hospital, Heping, Fuyou Branch, Taipei, Taiwan. Electronic address: ytchen0117@gmail.com.
Abstract
OBJECTIVES: The elderly (aged ≥65 years) population with type 2 diabetes (T2D) is growing substantially, but evidence for associations between the use of dipeptidyl peptidase-4 inhibitors (DPP-4is), novel incretin-based antidiabetic drugs, and clinical hard endpoints in this group remains inconclusive. We aimed to assess the safety and cardiovascular effects of DPP-4i use in a nationally representative sample of elderly adults with T2D. DESIGN, SETTING, AND PARTICIPANTS: We conducted a nationwide, observational, propensity score-matched study using Taiwan's National Health Insurance Research Database. Of a total of 414,213 patients aged ≥65 years with T2D, 58,485 patients receiving initial DPP-4i prescriptions between March 1, 2009, and June 31, 2013, were included. Each DPP-4i user was matched with a nonuser control using propensity scores. The endpoints were all-cause mortality and major adverse cardiovascular events (MACEs), including ischemic stroke and myocardial infarction. Potential adverse effects of hospitalization for heart failure and hypoglycemia were also evaluated. RESULTS: Compared with the matched control cohort, the risks of all-cause mortality (hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.52-0.56), MACEs (HR 0.79, 95% CI 0.75-0.83), myocardial infarction (HR 0.79, 95% CI 0.72-0.87), and ischemic stroke (HR 0.79, 95% CI 0.75-0.84) were lower in the DPP-4i cohort. DPP-4i use did not affect the risks of hospitalization for heart failure and hypoglycemia. Stratified analyses produced consistent results across age, sex, and comorbidity subgroups. CONCLUSIONS: Prescription of DPP-4is was associated with reduced risks of all-cause mortality and MACEs in patients aged ≥65 years with T2D.
OBJECTIVES: The elderly (aged ≥65 years) population with type 2 diabetes (T2D) is growing substantially, but evidence for associations between the use of dipeptidyl peptidase-4 inhibitors (DPP-4is), novel incretin-based antidiabetic drugs, and clinical hard endpoints in this group remains inconclusive. We aimed to assess the safety and cardiovascular effects of DPP-4i use in a nationally representative sample of elderly adults with T2D. DESIGN, SETTING, AND PARTICIPANTS: We conducted a nationwide, observational, propensity score-matched study using Taiwan's National Health Insurance Research Database. Of a total of 414,213 patients aged ≥65 years with T2D, 58,485 patients receiving initial DPP-4i prescriptions between March 1, 2009, and June 31, 2013, were included. Each DPP-4i user was matched with a nonuser control using propensity scores. The endpoints were all-cause mortality and major adverse cardiovascular events (MACEs), including ischemic stroke and myocardial infarction. Potential adverse effects of hospitalization for heart failure and hypoglycemia were also evaluated. RESULTS: Compared with the matched control cohort, the risks of all-cause mortality (hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.52-0.56), MACEs (HR 0.79, 95% CI 0.75-0.83), myocardial infarction (HR 0.79, 95% CI 0.72-0.87), and ischemic stroke (HR 0.79, 95% CI 0.75-0.84) were lower in the DPP-4i cohort. DPP-4i use did not affect the risks of hospitalization for heart failure and hypoglycemia. Stratified analyses produced consistent results across age, sex, and comorbidity subgroups. CONCLUSIONS: Prescription of DPP-4is was associated with reduced risks of all-cause mortality and MACEs in patients aged ≥65 years with T2D.
Authors: Mugdha Gokhale; John B Buse; Michele Jonsson Funk; Jennifer Lund; Virginia Pate; Ross J Simpson; Til Stürmer Journal: Diabetes Obes Metab Date: 2017-03-17 Impact factor: 6.577
Authors: Sheriza N Baksh; Jodi B Segal; Mara McAdams-DeMarco; Rita R Kalyani; G Caleb Alexander; Stephan Ehrhardt Journal: PLoS One Date: 2020-10-15 Impact factor: 3.240