K A Toulis1, W Hanif2, P Saravanan3, B H Willis4, T Marshall4, B Kumarendran4, K Gokhale4, S Ghosh2, K K Cheng4, P Narendran5, G N Thomas6, K Nirantharakumar7. 1. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom; 424 General Military Hospital, Thessaloniki, Greece. 2. Diabetes Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom. 3. University of Warwick & George Eliot Hospital, Coventry, United Kingdom. 4. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom. 5. Diabetes Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom. 6. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom. Electronic address: gneilthomas@yahoo.co.uk. 7. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom; Diabetes Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom. Electronic address: k.nirantharan@bham.ac.uk.
Abstract
AIM: The glucagon-like peptide-1 receptor agonist (GLP1a) liraglutide has been described to benefit patients with type 2 diabetes mellitus (T2DM) at high cardiovascular risk. However, there are still uncertainties relating to these cardiovascular benefits: whether they also apply to an unselected diabetic population that includes low-risk patients, represent a class-effect, and could be observed in a real-world setting. METHODS: We conducted a population-based, retrospective open cohort study using data derived from The Health Improvement Network database between Jan 2008 to Sept 2015. Patients with T2DM exposed to GLP1a (n=8345) were compared to age, gender, body mass index, duration of T2DM and smoking status-matched patients with T2DM unexposed to GLP1a (n=16,541). RESULTS: Patients with diabetes receiving GLP1a were significantly less likely to die from any cause compared to matched control patients with diabetes (adjusted incidence rate ratio [aIRR]: 0.64, 95% CI: 0.56-0.74, P-value<0.0001). Similar findings were observed in low-risk patients (aIRR: 0.64, 95% CI: 0.53-0.76, P -value=0.0001). No significant difference in the risk of incident CVD was detected in the low-risk patients (aIRR: 0.93, 95% CI: 0.83-1.12). Subgroup analyses suggested that effect is persistent in the elderly or across glycated haemoglobin categories. CONCLUSIONS: GLP1a treatment in a real-world setting may confer additional mortality benefit in patients with T2DM irrespective of their baseline CVD risk, age or baseline glycated haemoglobin and was sustained over the observation period.
AIM: The glucagon-like peptide-1 receptor agonist (GLP1a) liraglutide has been described to benefit patients with type 2 diabetes mellitus (T2DM) at high cardiovascular risk. However, there are still uncertainties relating to these cardiovascular benefits: whether they also apply to an unselected diabetic population that includes low-risk patients, represent a class-effect, and could be observed in a real-world setting. METHODS: We conducted a population-based, retrospective open cohort study using data derived from The Health Improvement Network database between Jan 2008 to Sept 2015. Patients with T2DM exposed to GLP1a (n=8345) were compared to age, gender, body mass index, duration of T2DM and smoking status-matched patients with T2DM unexposed to GLP1a (n=16,541). RESULTS:Patients with diabetes receiving GLP1a were significantly less likely to die from any cause compared to matched control patients with diabetes (adjusted incidence rate ratio [aIRR]: 0.64, 95% CI: 0.56-0.74, P-value<0.0001). Similar findings were observed in low-risk patients (aIRR: 0.64, 95% CI: 0.53-0.76, P -value=0.0001). No significant difference in the risk of incident CVD was detected in the low-risk patients (aIRR: 0.93, 95% CI: 0.83-1.12). Subgroup analyses suggested that effect is persistent in the elderly or across glycated haemoglobin categories. CONCLUSIONS: GLP1a treatment in a real-world setting may confer additional mortality benefit in patients with T2DM irrespective of their baseline CVD risk, age or baseline glycated haemoglobin and was sustained over the observation period.
Authors: Konstantinos A Toulis; Krishnarajah Nirantharakumar; Chrysa Pourzitaki; Anthony H Barnett; Abd A Tahrani Journal: Drugs Date: 2020-04 Impact factor: 9.546
Authors: Christina Antza; Krishnarajah Nirantharakumar; Ioannis Doundoulakis; Abd A Tahrani; Konstantinos A Toulis Journal: Drug Des Devel Ther Date: 2019-08-22 Impact factor: 4.162
Authors: Thomas M Caparrotta; Jack B Templeton; Thomas A Clay; Sarah H Wild; Rebecca M Reynolds; David J Webb; Helen M Colhoun Journal: Diabetes Ther Date: 2021-02-26 Impact factor: 2.945
Authors: Michael W O'Reilly; Marija Glisic; Balachandran Kumarendran; Anuradhaa Subramanian; Konstantinos N Manolopoulos; Abd A Tahrani; Deepi Keerthy; Taulant Muka; Konstantinos A Toulis; Wasim Hanif; G Neil Thomas; Oscar H Franco; Wiebke Arlt; Krishnarajah Nirantharakumar Journal: Clin Endocrinol (Oxf) Date: 2018-10-23 Impact factor: 3.478