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Comparison of diabetes‐associated secondary healthcare utilization between alternative oral antihyperglycaemic dual therapy combinations with metformin in patients with type 2 diabetes: an observational cohort study
Author(s) -
Strongman H.,
D'Oca K.,
Langerman H.,
Das R.
Publication year - 2015
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.12458
Subject(s) - medicine , metformin , propensity score matching , type 2 diabetes , cohort , retrospective cohort study , cohort study , diabetes mellitus , rate ratio , confidence interval , endocrinology , insulin
Aims To compare diabetes‐associated secondary healthcare utilization in patients with type 2 diabetes ( T2DM ) prescribed sulphonylureas ( SUs ) versus other oral antihyperglycaemic agents ( OHAs ) as an add‐on to metformin monotherapy (metformin + SU vs metformin + OHA ). Methods This retrospective cohort study used data from the C linical P ractice R esearch D atalink linked to H ospital E pisode S tatistics. Adults with T2DM initiated on metformin + SU or metformin + OHA from A pril 2003 to M arch 2012 were identified. Patients were matched using propensity scores. Diabetes‐associated secondary healthcare visits were counted from >6 months post‐initiation of dual therapy until treatment change or end of follow‐up. Outcomes were calculated as rate ratios, adjusted for over‐dispersion using negative binomial regression and propensity score for covariates. Results After propensity score matching, 1704 patients were included in each cohort. For the primary objective (diabetes‐associated inpatient and outpatient visits combined), the metformin + SU cohort had a directionally higher rate of diabetes‐associated secondary healthcare utilization than the metformin + OHA cohort [adjusted rate ratio 1.12, 95% confidence interval ( CI ) 0.97–1.29]. For the secondary outcomes, the adjusted rate ratio was 1.38 (95% CI 0.95–2.00) for inpatient admissions and 1.10 (95% CI 0.95–1.28) for outpatient visits. Macrovascular complications, accounting for 77.2% of inpatient admissions, occurred at a statistically significantly higher rate in the metformin + SU cohort than in the metformin + OHA cohort (adjusted rate ratio 1.77, 95% CI 1.15–2.71). Conclusions This study found a statistically significant higher rate of inpatient admissions for macrovascular complications and cardiology outpatient visits and, overall, a directionally higher rate of secondary healthcare utilization for patients prescribed metformin + SU than for those prescribed metformin + OHA . This adds to the evidence that long‐term and health economic outcomes should be considered in treatment decisions for patients with type 2 diabetes.