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Risk of type 2 diabetes mellitus by antimuscarinic agents among adult females receiving care in the military health system
Author(s) -
Selig Daniel J.,
Brown Aaron J.,
DeLuca Jesse P.,
Kress Adrian T.,
Livezey Jeffrey R.,
Oliver Thomas G.,
Por Elaine D.,
Thelus Jean Rosenie
Publication year - 2020
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.5090
Subject(s) - solifenacin , oxybutynin , tolterodine , medicine , type 2 diabetes mellitus , overactive bladder , retrospective cohort study , diabetes mellitus , urology , endocrinology , alternative medicine , pathology
Purpose To explore patterns of antimuscarinic medication as a risk factor for type 2 diabetes mellitus (T2DM). Methods This is a retrospective cohort study of females 18 years or older within the Military Health System from 2006 to 2016. Administrative and claims data were used to select patients who initiated therapy with tolterodine, fesoterodine, oxybutynin, darifenacin, solifenacin, or trospium. Patients with no documented history of T2DM were followed for the occurrence of T2DM, the end of the study or loss of eligibility. Rates of T2DM were calculated for the overall population, by duration of therapy and by individual drug s . Crude and adjusted Cox proportional hazards were calculated to assess differences by duration of use and specific muscarinic antagonist. Results Over 2.6 million antimuscarinic prescriptions were dispensed to 241 829 females (mean age/SD, 62 ± 18 years). Patients exposed to M 3 selective antagonists had highest risk of developing T2DM compared to those exposed to nonselective antagonists. Using oxybutynin, a nonselective antagonist as a comparator, adjusted rate ratios of T2DM were 57% (HR 1.57, 95%CI 1.48‐1.67) and 29% (HR 1.29, 95%CI 1.24‐1.35) significantly higher for darifenacin and solifenacin, respectively (both M 3 selective). Conclusions We found exposure to M 3 selective antagonists darifenacin and solifenacin had the highest risk of developing T2DM compared to nonselective antagonist oxybutynin. This is supported by well described physiologic mechanisms and may allow for more informed prescribing decisions, particularly if minimizing risk of T2DM is a priority.