Abstract
BACKGROUND
Dipeptidyl peptidase-4 (DPP4) inhibitors are widely used to treat type 2 diabetes mellitus (T2DM). In a previous study, we demonstrated a plausible mechanism how DPP4 inhibitors may cause accumulation of stroma derived factor-1 (SDF1) in ischemic retina, leading to vascular permeability and diabetic retinopathy (DR). We sought to investigate the association of DPP4 inhibitors with DR in patients using the Korean National Health Insurance Service (NHIS) data.
METHODS
This was a retrospective, population-based cohort study using the Korean NHIS database. The Korean NHIS is a government-run, mandatory medical insurance service and keeps records of patient sociodemographic data, inpatient and outpatient medical services and prescriptions. The database consists of records from the entire Korean, totaling 51 million people, regardless of the medical institution from which they received service.
RESULTS
Among the total study population, 26.0% (152,149 of 585,191) received prescriptions of DPP4 inhibitors. The incidence of DR in the DPP4 inhibitor group was 55.03 per 1,000 person-years (PPY), compared to 50.17 PPY in the non-DPP4 group (P < 0.001). Patients prescribed with DPP4 inhibitors as second-line therapy had a 9% increased risk of developing DR compared to those on other medications after adjustment for age, gender, hypertension, dyslipidemia, and duration of disease (adjusted HR 1.09, 95% CI 1.07–1.11, P < 0.001).
CONCLUSIONS
In Korean T2DM patients that received second line oral hypoglycemic agents, DPP4 inhibitor prescription was associated with a higher risk of newly-developed DR, suggesting that the effect of DPP4 inhibitors on vascular permeability and neovascularization may have clinical implications.
Sitagliptin and risk of heart failure hospitalization in patients with type 2 diabetes on dialysis: A population-based cohort study
