OBJECTIVES

: Type 2 Diabetes (T2D) increases the risk of cardiovascular diseases (CVD). However, limited studies demonstrated the risk of CVD related to anti-diabetes medications in adults with T2D and with advanced chronic kidney disease (CKD). This study aimed to compare the risk of CVD and all-cause mortality in adults with T2D and with advanced CKD who received sulfonylurea, dipeptidyl peptidase-4 (DPP-4), thiazolidinedione, α-glucosidase inhibitor or glinide.

METHODS

: We prospectively studied adults with T2D who used erythropoietin, as an indicator for advanced CKD, from January 1, 2009 to December 31, 2012, in Taiwan’s National Health Insurance Research Database. Follow-up ended on December 31, 2013. We identified 5,415 adults with T2D who received prescriptions of single anti-diabetes medication within 90 days of the first EPO prescription, excluding those with coronary heart disease, stroke, amputation, heart failure, or dialysis in 30 days before the prescription of anti-diabetes medication. The composite primary outcome included CVD (coronary heart disease, stroke, amputation, heart failure) and all-cause mortality. Cox regression estimated hazard ratio with adjustment for age, gender, T2D duration, CVD, Comorbid condition, Antidiabetic medication, Antihypertensive medication, antiplatelet and Statin use .

RESULTS

: After 1:4 ration propensity score matching, 302 sulfonylurea users, 23 thiazolidinedione users, 61 DPP-4 users and 37 𝛂-glucosidase inhibitor users were matched to 663, 41, 105 and 72 glinide users, respectively. These 2589 matched samples (mean age, 64.5 years; T2D duration, 8.4 years) contributed to an average of 8.5 months (SD=9.8) of follow-up. Multivariable-adjusted hazard ratio for the primary outcome were 0.89 (p=0.11) comparing sulfonylurea with glinide, 0.57 (p=0.17) comparing thiazolidinedione with glinide, 1.17 (p=0.42) for DPP-4 versus glinide, and 1.10 (p=0.68) for 𝛂-glucosidase inhibitor versus glinide.

CONCLUSIONS

: In adults with T2D and with advance CKD, sulfonylurea, thiazolidinedione, DPP-4 and 𝛂-glucosidase inhibitor seemed to not increase the risk of CVD as compared with glinides.