Fu-Shun Yen1, James Cheng-Chung Wei2,3,4, Mei-Chen Lin5,6, Chih-Cheng Hsu7,8,9, Chii-Min Hwu10,11. 1. Dr. Yen's Clinic, No. 15, Shanying Road, Gueishan District, Taoyuan, 33354, Taiwan. 2. Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City, 40201, Taiwan. 3. Department of Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City, 40201, Taiwan. 4. Graduate Institute of Integrated Medicine, China Medical University, No.91, Hsueh-Shih Road, Taichung, 40402, Taiwan. 5. Management Office for Health Data, China Medical University Hospital, 3F., No.373-2, Jianxing Road, Taichung, 40459, Taiwan. 6. College of Medicine, China Medical University, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City, 40201, Taiwan. 7. Institute of Population Health Sciences, National Health Research Institutes, No.35, Keyan Rd., Zhunan Township, Miaoli, 35053, Taiwan. cch@nhri.edu.tw. 8. Department of Health Services Administration, China Medical University, No.91, Hsueh-Shih Road, Taichung, 40402, Taiwan. cch@nhri.edu.tw. 9. Department of Family Medicine, Min-Sheng General Hospital, 168 ChingKuo Road, Taoyuan, 33044, Taiwan. cch@nhri.edu.tw. 10. Faculty of Medicine, National Yang-Ming University School of Medicine, No. 201, Sec. 2 Shi-Pai Rd., Chung-Cheng Build. 11F Room 522, Taipei, 112, Taiwan. chhwu@vghtpe.gov.tw. 11. Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2 Shi-Pai Rd., Chung-Cheng Build. 11F Room 522, Taipei, 112, Taiwan. chhwu@vghtpe.gov.tw.
Abstract
BACKGROUND: In insulin-treated patients with type 2 diabetes mellitus (T2DM), glycemic control is usually suboptimal. METHODS: This study compared the risks of mortality and cardiovascular events in insulin-treated patients adding or not adding alpha-glucosidase inhibitors (AGIs). RESULTS: This cohort study included data from the Taiwan National Health Insurance Research Database. In total, 17,417 patients newly diagnosed as having T2DM and undergoing insulin therapy during 2000-2012 were enrolled. Overall incidence rates of all-cause mortality, hospitalized coronary artery disease (CAD), stroke, and heart failure were compared between 4165 AGI users and 4165 matched nonusers. The incidence rates of all-cause mortality were 17.10 and 19.61 per 1000 person-years in AGI nonusers and users, respectively. Compared with nonusers, AGI users had a higher mortality risk [adjusted hazard ratio (aHR) = 1.21, 95% confidence interval (CI) = 1.05-1.40; p = 0.01]. Regarding AGI use, aHRs (95% CI) for cardiovascular death, non-cardiovascular death, hospitalized CAD, stroke, and heart failure were 1.20 (0.83-1.74), 1.27 (1.07-1.50), 1.12 (0.95-1.31), 0.98 (0.85-1.14), and 1.03 (0.87-1.22) respectively. CONCLUSION: AGI use was associated with higher risks of all-cause mortality and non-cardiovascular death in insulin-treated patients with T2DM. Therefore, adding AGIs in insulin-treated patients may not be appropriate.
BACKGROUND: In insulin-treated patients with type 2 diabetes mellitus (T2DM), glycemic control is usually suboptimal. METHODS: This study compared the risks of mortality and cardiovascular events in insulin-treated patients adding or not adding alpha-glucosidase inhibitors (AGIs). RESULTS: This cohort study included data from the Taiwan National Health Insurance Research Database. In total, 17,417 patients newly diagnosed as having T2DM and undergoing insulin therapy during 2000-2012 were enrolled. Overall incidence rates of all-cause mortality, hospitalized coronary artery disease (CAD), stroke, and heart failure were compared between 4165 AGI users and 4165 matched nonusers. The incidence rates of all-cause mortality were 17.10 and 19.61 per 1000 person-years in AGI nonusers and users, respectively. Compared with nonusers, AGI users had a higher mortality risk [adjusted hazard ratio (aHR) = 1.21, 95% confidence interval (CI) = 1.05-1.40; p = 0.01]. Regarding AGI use, aHRs (95% CI) for cardiovascular death, non-cardiovascular death, hospitalized CAD, stroke, and heart failure were 1.20 (0.83-1.74), 1.27 (1.07-1.50), 1.12 (0.95-1.31), 0.98 (0.85-1.14), and 1.03 (0.87-1.22) respectively. CONCLUSION: AGI use was associated with higher risks of all-cause mortality and non-cardiovascular death in insulin-treated patients with T2DM. Therefore, adding AGIs in insulin-treated patients may not be appropriate.
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