Open AccessImpacts of early insulin treatment vs glimepiride in diabetic patients with background metformin therapy
Author(s) -
FuShun Yen,
ChihCheng Hsu,
YiChang Su,
James ChengChung Wei,
ChiiMin Hwu
Publication year - 2021
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000025085
Subject(s) - medicine , glimepiride , hazard ratio , metformin , insulin , hypoglycemia , type 2 diabetes , diabetes mellitus , propensity score matching , proportional hazards model , retrospective cohort study , cohort study , endocrinology , confidence interval
Type 2 diabetes mellitus (T2DM) is a progressive disease. After metformin failure, the addition of insulin or sulfonylureas might increase the risk of hypoglycemia and cardiovascular (CV) morbidity. Here, the risk of all-cause mortality was compared between early insulin treatment and glimepiride use in T2DM patients with background metformin therapy. We conducted a 9-year retrospective cohort study from the population-based National Health Insurance Research Database in Taiwan. A total of 2054 patients with T2DM under insulin or glimepiride treatment were enrolled during 2004 to 2012. Overall event rates of all-cause mortality were compared between 1027 insulin users and 1027 matched glimepiride users. After the propensity score matching, the mortality rates were 72.5 and 4.42 per 1000 person-years for insulin users and glimepiride users. The adjusted hazard ratio of mortality was 14.47 (95% CI: 8.64–24.24; P value <.001) as insulin compared with glimepiride users. The insulin users had significantly higher risk of CV death (adjusted hazard ratio 7.95, 95% CI 1.65–38.3, P = .01) and noncardiovascular death (adjusted hazard ratio 14.9, 95% CI 8.4–26.3, P < .001). The nationwide study demonstrated that metformin plus insulin therapy was associated with higher risk of all-cause mortality.