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Novel oral glucose‐lowering drugs are associated with lower risk of all‐cause mortality, cardiovascular events and severe hypoglycaemia compared with insulin in patients with type 2 diabetes
Author(s) -
Nyström Thomas,
Bodegard Johan,
Nathanson David,
Thuresson Marcus,
Norhammar Anna,
Eriksson Jan W.
Publication year - 2017
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.12889
Subject(s) - dapagliflozin , medicine , hazard ratio , insulin , type 2 diabetes , diabetes mellitus , proportional hazards model , confidence interval , lower risk , gastroenterology , endocrinology
Aims To investigate the association of novel oral glucose‐lowering drugs ( GLDs ), compared with that of insulin, with risk of all‐cause mortality, cardiovascular disease ( CVD ) and severe hypoglycaemia. Methods During 2013 to 2014 all patients with type 2 diabetes in Sweden identified as new users of novel oral GLDs , either dipeptidyl peptidase‐4 ( DPP ‐4) inhibitors or sodium‐glucose cotransporter‐2 ( SGLT2 ) inhibitors (only dapagliflozin available in Sweden during the study period), with those initiating insulin as a comparison group, in the Prescribed Drug Register were included and followed in the Patient and Cause of Death Registers. The novel GLD group and insulin group were matched 1:1 using propensity score. Cox regression models were used to estimate risks. Results Of 37 603 patients, 21 758 were matched 1:1 to novel GLD vs insulin groups, with median follow‐up times of 1.51 years (16 304 patient‐years) and 1.53 years (16 306 patient‐years), respectively. Treatment with novel GLDs was associated with a 44% (hazard ratio [ HR ] 0.56 [95% confidence interval { CI } 0.49‐0.64]), 15% ( HR 0.85 [95% CI 0.73‐0.99]) and 74% (0.26 [95% CI 0.12‐0.57]) lower risk of all‐cause mortality, CVD and hypoglycaemia, respectively, compared with insulin treatment. In separate analyses for the two novel GLDs , dapagliflozin was associated with lower risks of all‐cause mortality and CVD (56% [ HR 0.44, 95% CI 0.28‐0.70] and 49% [ HR 0.51, 95% CI 0.30‐0.86], respectively), while DPP ‐4 inhibitor treatment was associated with lower risk of all‐cause mortality (41% [ HR 0.59, 95% CI 0.51‐0.67]), but not with CVD ( HR 0.87, 95% CI 0.75‐1.01). Conclusions Novel oral GLD treatment was associated with lower risk of all‐cause mortality, CVD and severe hypoglycaemia compared with insulin treatment. Dapagliflozin was associated with a lower risk of both all‐cause mortality and CVD , whereas DPP ‐4 inhibitor treatment was only associated with lower risk of all‐cause mortality.