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Treatment persistence, hypoglycaemia and clinical outcomes in type 2 diabetes patients with dipeptidyl peptidase-4 inhibitors and sulphonylureas: a primary care database analysis.
Diabetes Obes Metab. 2013 Jan; 15(1):55-61.DO

Abstract

AIMS

To investigate therapy persistence, frequency of hypoglycaemia and macrovascular outcomes among type 2 diabetes patients with dipeptidyl peptidase-4 (DPP-4) inhibitors (DPP-4) and sulphonylureas (SU).

METHODS

Data from 19,184 DPP-4 (mean age: 64 years; 56% males) and 31,110 SU users (69 years; 51%) with new prescriptions (index date), without additional antidiabetics except metformin, in 1201 general practises in Germany were analysed. Therapy discontinuation (prescription gap >90 days), hypoglycaemia [International Classification of Diseases (ICD-10)] and macrovascular outcomes (ICD-10) (2-year follow-up) were compared adjusting for age, sex, diabetes duration, metformin, previous hypoglycaemia, health insurance, hypertension, hyperlipidaemia, antihypertensives, lipid-lowering and antithrombotic drugs, microvascular complications and Charlson co-morbidity score using logistic or Cox regression models.

RESULTS

Two years after index date, DDP-4 (non-persistence: 39%) were associated with a lower risk of discontinuation compared to SU (49%) [adjusted hazard ratio (HR): 0.74; 95% confidence interval (CI): 0.71-0.76]. Hypoglycaemias (≥1) were documented in 0.18% patients with DPP-4 and in 1.00% with SU [odds ratio (OR): 0.21; 95%CI: 0.08-0.57]. Hypoglycaemias were significantly associated with incident macrovascular complications (HR: 1.6; 95% CI: 1.1-2.2). Risk of macrovascular events was 26% lower in DPP-4 than in SU users.

CONCLUSIONS

Lack of persistence with antidiabetic therapy is frequently found in primary care patients. DPP-4 was associated with lower therapy discontinuation and a fivefold reduced frequency of patients with hypoglycaemia compared to SU. The low absolute numbers of hypoglycaemias are most likely due to the fact that only severe events were documented. DPP-4 treatment was associated with reduced incidence of macrovascular events relative to SU in type 2 diabetes patients in primary care practises.

Authors+Show Affiliations

Institute of Biometrics and Epidemiology, German Diabetes Center, Dusseldorf, Germany. rathmann@ddz.uni-duesseldorf.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22862879

Citation

Rathmann, W, et al. "Treatment Persistence, Hypoglycaemia and Clinical Outcomes in Type 2 Diabetes Patients With Dipeptidyl Peptidase-4 Inhibitors and Sulphonylureas: a Primary Care Database Analysis." Diabetes, Obesity & Metabolism, vol. 15, no. 1, 2013, pp. 55-61.
Rathmann W, Kostev K, Gruenberger JB, et al. Treatment persistence, hypoglycaemia and clinical outcomes in type 2 diabetes patients with dipeptidyl peptidase-4 inhibitors and sulphonylureas: a primary care database analysis. Diabetes Obes Metab. 2013;15(1):55-61.
Rathmann, W., Kostev, K., Gruenberger, J. B., Dworak, M., Bader, G., & Giani, G. (2013). Treatment persistence, hypoglycaemia and clinical outcomes in type 2 diabetes patients with dipeptidyl peptidase-4 inhibitors and sulphonylureas: a primary care database analysis. Diabetes, Obesity & Metabolism, 15(1), 55-61. https://doi.org/10.1111/j.1463-1326.2012.01674.x
Rathmann W, et al. Treatment Persistence, Hypoglycaemia and Clinical Outcomes in Type 2 Diabetes Patients With Dipeptidyl Peptidase-4 Inhibitors and Sulphonylureas: a Primary Care Database Analysis. Diabetes Obes Metab. 2013;15(1):55-61. PubMed PMID: 22862879.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment persistence, hypoglycaemia and clinical outcomes in type 2 diabetes patients with dipeptidyl peptidase-4 inhibitors and sulphonylureas: a primary care database analysis. AU - Rathmann,W, AU - Kostev,K, AU - Gruenberger,J B, AU - Dworak,M, AU - Bader,G, AU - Giani,G, Y1 - 2012/09/09/ PY - 2012/06/15/received PY - 2012/07/10/revised PY - 2012/07/31/accepted PY - 2012/8/7/entrez PY - 2012/8/7/pubmed PY - 2013/7/3/medline SP - 55 EP - 61 JF - Diabetes, obesity & metabolism JO - Diabetes Obes Metab VL - 15 IS - 1 N2 - AIMS: To investigate therapy persistence, frequency of hypoglycaemia and macrovascular outcomes among type 2 diabetes patients with dipeptidyl peptidase-4 (DPP-4) inhibitors (DPP-4) and sulphonylureas (SU). METHODS: Data from 19,184 DPP-4 (mean age: 64 years; 56% males) and 31,110 SU users (69 years; 51%) with new prescriptions (index date), without additional antidiabetics except metformin, in 1201 general practises in Germany were analysed. Therapy discontinuation (prescription gap >90 days), hypoglycaemia [International Classification of Diseases (ICD-10)] and macrovascular outcomes (ICD-10) (2-year follow-up) were compared adjusting for age, sex, diabetes duration, metformin, previous hypoglycaemia, health insurance, hypertension, hyperlipidaemia, antihypertensives, lipid-lowering and antithrombotic drugs, microvascular complications and Charlson co-morbidity score using logistic or Cox regression models. RESULTS: Two years after index date, DDP-4 (non-persistence: 39%) were associated with a lower risk of discontinuation compared to SU (49%) [adjusted hazard ratio (HR): 0.74; 95% confidence interval (CI): 0.71-0.76]. Hypoglycaemias (≥1) were documented in 0.18% patients with DPP-4 and in 1.00% with SU [odds ratio (OR): 0.21; 95%CI: 0.08-0.57]. Hypoglycaemias were significantly associated with incident macrovascular complications (HR: 1.6; 95% CI: 1.1-2.2). Risk of macrovascular events was 26% lower in DPP-4 than in SU users. CONCLUSIONS: Lack of persistence with antidiabetic therapy is frequently found in primary care patients. DPP-4 was associated with lower therapy discontinuation and a fivefold reduced frequency of patients with hypoglycaemia compared to SU. The low absolute numbers of hypoglycaemias are most likely due to the fact that only severe events were documented. DPP-4 treatment was associated with reduced incidence of macrovascular events relative to SU in type 2 diabetes patients in primary care practises. SN - 1463-1326 UR - https://www.unboundmedicine.com/medline/citation/22862879/Treatment_persistence_hypoglycaemia_and_clinical_outcomes_in_type_2_diabetes_patients_with_dipeptidyl_peptidase_4_inhibitors_and_sulphonylureas:_a_primary_care_database_analysis_ L2 - https://doi.org/10.1111/j.1463-1326.2012.01674.x DB - PRIME DP - Unbound Medicine ER -