Second-line glucose-lowering drugs added to metformin and the risk of hospitalization for heart failure: A nationwide cohort study

Su Jin Lee, Kyoung Hwa Ha, Jung Hyun Lee, Hokyou Lee, Dae Jung Kim, HyeonChang Kim

Research output: Contribution to journalArticle

Abstract

Aim: To compare the risks of hospitalization for heart failure (HHF) associated with sulfonylurea (SU), dipeptidyl peptidase-4 inhibitor (DPP-4i), and thiazolidinedione (TZD) as add-on medications to metformin (MET) therapy using the data of Korean adults with type-2 diabetes from the Korean National Health Insurance database. Methods: We identified 98,383 people who received SU (n = 42,683), DPP-4i (n = 50,310), or TZD (n = 5,390) added to initial treatment of MET monotherapy in patients with type-2 diabetes. The main outcome was the hospitalization for HHF. Hazard ratios for HHF by type of second-line glucose-lowering medication were estimated by Cox-proportional hazard models. Sex, age, duration of MET monotherapy, Charlson Comorbidity Index and additional comor-bidities, and calendar year were controlled as potential confounders. Results: The observed numbers (rate per 100,000 person-years) of HHF events were 1,129 (658) for MET+SU users, 710 (455) for MET+DPP-4i users, and 110 (570) for MET+TZD users. Compared to that for MET+SU users (reference group), the adjusted hazard ratios for HHF events were 0.76 (95% confidence interval 0.69-0.84) for MET+DPP-4i users and 0.96 (95% confidence interval 0.79-1.17) for MET+TZD users. Conclusion: DPP-4i as an add-on therapy to MET may lower the risks of HHF compared with SU.

Original languageEnglish
Article numbere0211959
JournalPloS one
Volume14
Issue number2
DOIs
Publication statusPublished - 2019 Feb 1

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metformin
Metformin
heart failure
cohort studies
Hospitalization
Cohort Studies
Heart Failure
Dipeptidyl-Peptidase IV Inhibitors
sulfonylureas
Glucose
drugs
glucose
peptidases
Pharmaceutical Preparations
Hazards
Medical problems
noninsulin-dependent diabetes mellitus
Type 2 Diabetes Mellitus
drug therapy
confidence interval

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Lee, Su Jin ; Ha, Kyoung Hwa ; Lee, Jung Hyun ; Lee, Hokyou ; Kim, Dae Jung ; Kim, HyeonChang. / Second-line glucose-lowering drugs added to metformin and the risk of hospitalization for heart failure : A nationwide cohort study. In: PloS one. 2019 ; Vol. 14, No. 2.
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abstract = "Aim: To compare the risks of hospitalization for heart failure (HHF) associated with sulfonylurea (SU), dipeptidyl peptidase-4 inhibitor (DPP-4i), and thiazolidinedione (TZD) as add-on medications to metformin (MET) therapy using the data of Korean adults with type-2 diabetes from the Korean National Health Insurance database. Methods: We identified 98,383 people who received SU (n = 42,683), DPP-4i (n = 50,310), or TZD (n = 5,390) added to initial treatment of MET monotherapy in patients with type-2 diabetes. The main outcome was the hospitalization for HHF. Hazard ratios for HHF by type of second-line glucose-lowering medication were estimated by Cox-proportional hazard models. Sex, age, duration of MET monotherapy, Charlson Comorbidity Index and additional comor-bidities, and calendar year were controlled as potential confounders. Results: The observed numbers (rate per 100,000 person-years) of HHF events were 1,129 (658) for MET+SU users, 710 (455) for MET+DPP-4i users, and 110 (570) for MET+TZD users. Compared to that for MET+SU users (reference group), the adjusted hazard ratios for HHF events were 0.76 (95{\%} confidence interval 0.69-0.84) for MET+DPP-4i users and 0.96 (95{\%} confidence interval 0.79-1.17) for MET+TZD users. Conclusion: DPP-4i as an add-on therapy to MET may lower the risks of HHF compared with SU.",
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Second-line glucose-lowering drugs added to metformin and the risk of hospitalization for heart failure : A nationwide cohort study. / Lee, Su Jin; Ha, Kyoung Hwa; Lee, Jung Hyun; Lee, Hokyou; Kim, Dae Jung; Kim, HyeonChang.

In: PloS one, Vol. 14, No. 2, e0211959, 01.02.2019.

Research output: Contribution to journalArticle

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T1 - Second-line glucose-lowering drugs added to metformin and the risk of hospitalization for heart failure

T2 - A nationwide cohort study

AU - Lee, Su Jin

AU - Ha, Kyoung Hwa

AU - Lee, Jung Hyun

AU - Lee, Hokyou

AU - Kim, Dae Jung

AU - Kim, HyeonChang

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N2 - Aim: To compare the risks of hospitalization for heart failure (HHF) associated with sulfonylurea (SU), dipeptidyl peptidase-4 inhibitor (DPP-4i), and thiazolidinedione (TZD) as add-on medications to metformin (MET) therapy using the data of Korean adults with type-2 diabetes from the Korean National Health Insurance database. Methods: We identified 98,383 people who received SU (n = 42,683), DPP-4i (n = 50,310), or TZD (n = 5,390) added to initial treatment of MET monotherapy in patients with type-2 diabetes. The main outcome was the hospitalization for HHF. Hazard ratios for HHF by type of second-line glucose-lowering medication were estimated by Cox-proportional hazard models. Sex, age, duration of MET monotherapy, Charlson Comorbidity Index and additional comor-bidities, and calendar year were controlled as potential confounders. Results: The observed numbers (rate per 100,000 person-years) of HHF events were 1,129 (658) for MET+SU users, 710 (455) for MET+DPP-4i users, and 110 (570) for MET+TZD users. Compared to that for MET+SU users (reference group), the adjusted hazard ratios for HHF events were 0.76 (95% confidence interval 0.69-0.84) for MET+DPP-4i users and 0.96 (95% confidence interval 0.79-1.17) for MET+TZD users. Conclusion: DPP-4i as an add-on therapy to MET may lower the risks of HHF compared with SU.

AB - Aim: To compare the risks of hospitalization for heart failure (HHF) associated with sulfonylurea (SU), dipeptidyl peptidase-4 inhibitor (DPP-4i), and thiazolidinedione (TZD) as add-on medications to metformin (MET) therapy using the data of Korean adults with type-2 diabetes from the Korean National Health Insurance database. Methods: We identified 98,383 people who received SU (n = 42,683), DPP-4i (n = 50,310), or TZD (n = 5,390) added to initial treatment of MET monotherapy in patients with type-2 diabetes. The main outcome was the hospitalization for HHF. Hazard ratios for HHF by type of second-line glucose-lowering medication were estimated by Cox-proportional hazard models. Sex, age, duration of MET monotherapy, Charlson Comorbidity Index and additional comor-bidities, and calendar year were controlled as potential confounders. Results: The observed numbers (rate per 100,000 person-years) of HHF events were 1,129 (658) for MET+SU users, 710 (455) for MET+DPP-4i users, and 110 (570) for MET+TZD users. Compared to that for MET+SU users (reference group), the adjusted hazard ratios for HHF events were 0.76 (95% confidence interval 0.69-0.84) for MET+DPP-4i users and 0.96 (95% confidence interval 0.79-1.17) for MET+TZD users. Conclusion: DPP-4i as an add-on therapy to MET may lower the risks of HHF compared with SU.

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