Abstract 3226: Differences in Risk of Death according to Type of Oral Glucose-lowering Therapy in Patients with Diabetes: A Nationwide Study
Objectives: Diabetes is a major cardiovascular risk factor, but due to the lack of hard end-points in previous studies, the risk of death associated to various types of glucose-lowering agents is largely unknown.
Methods: All residents in Denmark aged over 20 years by 1997 without a prior myocardial infarction (MI) and treated with oral glucose-lowering therapy were followed from 1997 to 2006 by individual-level-linkage of nationwide administrative registers. Types of glucose-lowering therapy was identified by claimed prescriptions from pharmacies during the observation period. The risk of death was estimated by multivariable, time-dependent Cox proportional-hazard analyses, adjusted for age, gender, comorbidity and concomitant cardiovascular medication.
Results: In a total population of 4,096,777 individuals, oral glucose-lowering therapy was used in 149,481 (3,6%) subjects without a prior MI; and 38,523 (25.8%) died during the study period. Compared to metformin therapy increased risks of death were found for glimeperide, glibenclamide, glipizide; for those receiving 2 or more glucose-lowering agents (combination); and those having pauses in treatment (p-values were <0.001 for all) (Figure⇓). Similar risks as for metformin was found for gliclazide (p=0.2), repaglinide (p=0.94) and acarbose (p=0.08) (Figure⇓).
Conclusion: Increased risk of death was associated to single treatment with glimiperide, glibenclamide and glipizide compared to metformin. On the contrary treatment with gliclazide, repaglinide and acarbose demonstrated similar risks as metformin. These results indicate an association between mortality risk and type of glucose-lowering therapy.