國家衛生研究院 NHRI:Item 3990099045/9406

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Title:	Effects on clinical outcomes of adding dipeptidyl peptidase-4 inhibitors versus sulfonylureas to metformin therapy in patients with type 2 diabetes mellitus
Authors:	Ou, SM;Shih, CJ;Chao, PW;Chu, H;Kuo, SC;Lee, YJ;Wang, SJ;Yang, CY;Lin, CC;Chen, TJ;Tarng, DC;Li, SY;Chen, YT
Contributors:	Division of Infectious Diseases
Abstract:	Background: Recent studies concluded that dipeptidyl peptidase-4 (DPP-4) inhibitors provide glycemic control but also raised concerns about the risk for heart failure in patients with type 2 diabetes mellitus (T2DM). However, large-scale studies of the effects on cardiovascular outcomes of adding DPP-4 inhibitors versus sulfonylureas to metformin therapy remain scarce. Objective: To compare clinical outcomes of adding DPP-4 inhibitors versus sulfonylureas to metformin therapy in patients with T2DM. Design: Nationwide study using Taiwan's National Health Insurance Research Database. Setting: Taiwan. Patients: All patients with T2DM aged 20 years or older between 2009 and 2012. A total of 10 089 propensity score- matched pairs of DPP-4 inhibitor users and sulfonylurea users were examined. Measurements: Cox models with exposure to sulfonylureas and DPP-4 inhibitors included as time-varying covariates were used to compare outcomes. The following outcomes were considered: all-cause mortality, major adverse cardiovascular events (MACEs) (including ischemic stroke and myocardial infarction), hospitalization for heart failure, and hypoglycemia. Patients were followed until death or 31 December 2013. Results: DPP-4 inhibitors were associated with lower risks for all-cause death (hazard ratio [HR], 0.63 [95% CI, 0.55 to 0.72]), MACEs (HR, 0.68 [CI, 0.55 to 0.83]), ischemic stroke (HR, 0.64 [CI, 0.51 to 0.81]), and hypoglycemia (HR, 0.43 [CI, 0.33 to 0.56]) compared with sulfonylureas as add-on therapy to metformin but had no effect on risks for myocardial infarction and hospitalization for heart failure. Limitation: Observational study design. Conclusion: Compared with sulfonylureas, DPP-4 inhibitors were associated with lower risks for all-cause death, MACEs, ischemic stroke, and hypoglycemia when used as add-ons to metformin therapy.
Date:	2015-11
Relation:	Annals of Internal Medicine. 2015 Nov;163(9):663-672.
Link to:	http://dx.doi.org/10.7326/M15-0308
JIF/Ranking 2023:	http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=0003-4819&DestApp=IC2JCR
Cited Times(WOS):	https://www.webofscience.com/wos/woscc/full-record/WOS:000365610600003
Cited Times(Scopus):	http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=84946124911
Appears in Collections:	[Shu-Chen Kuo] Periodical Articles

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