Mortality in Individuals Treated with Glucose Lowering Agents: a Large, Controlled Cohort Study.

Mortality in Individuals Treated with Glucose Lowering Agents: a Large, Controlled Cohort Study.

J Clin Endocrinol Metab. 2015 Dec 17;:jc20153184

Authors: Claesen M, Gillard P, De Smet F, Callens M, De Moor B, Mathieu C

Abstract
CONTEXT: Several observational studies and meta-analyses have reported increased mortality of patients taking sulfonylurea and insulin. The impact of patient profiles and concomitant therapies often remains unclear.
OBJECTIVE: To quantify survival of patients after starting glucose-lowering agents (GLAs) and compare it to control subjects, matched for risk profiles and concomitant therapies.
DESIGN: Retrospective controlled cohort study.
SETTING: The study is based on health expenditure records of the largest Belgian health mutual insurer, covering over 4.4 million people.
PATIENTS: 115,896 patients starting metformin, sulfonylurea or insulin (alone or in combination) between January 2003 and December 2007. Control subjects without GLA therapy were matched for age, gender, history of cardiovascular events and therapy with antihypertensives, statins and blood platelet aggregation inhibitors.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE: 5-year survival after start of GLA.
RESULTS: Profiles of patients using different GLAs varied, with patients on sulfonylurea being oldest and patients on insulin having more frequently a history of cardiovascular disease. Excess mortality differed across GLA therapies compared to matched controls without GLAs, even after adjusting for observable characteristics. Only metformin monotherapy was not associated with increased 5-year mortality compared to matched controls, while individuals on combination of sulfonylurea and insulin had highest mortality risks. Age and concomitant use of statins strongly affect survival.
CONCLUSIONS: Differences exist in 5-year survival of patients on GLA, at least partly driven by the risk profile of the individuals themselves. Metformin use was associated with lowest 5-year mortality risk and statins dramatically lowered 5-year mortality throughout all cohorts.

PMID: 26678656 [PubMed - as supplied by publisher]

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