scholarly journals Monitoring the Comparative Safety of SGLT2i vs GLP-1 RA in Older Adults With Type 2 Diabetes by Frailty Status

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 209-210
Author(s):  
Alexander Kutz ◽  
Chandrasekar Gopalakrishnan ◽  
Dae Kim ◽  
Elisabetta Patorno
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Propensity Score ◽  
Diabetic Ketoacidosis ◽  
Propensity Score Matching ◽  
Frailty Status ◽  
Frail Patients ◽  
Comparative Safety ◽  
Sequential Analyses

Abstract Using Medicare (4/2013-12/2017), we conducted 9 sequential analyses of patients with type 2 diabetes initiating SGLT2i vs. GLP1-RA mimicking the accrual of new data every 6 months to monitor SGLT2i safety with respect to diabetic ketoacidosis (DKA) since their U.S. approval. For each analysis, we estimated cumulative HRs (95% CIs) after 1:1 propensity score matching on >70 covariates comparing treatments within frail and non-frail patients. By analysis 1, SGLT2i were associated with a higher DKA rate vs. GLP-1RA in both frail and non-frail patients, but results were highly imprecise due to few events. With the accrual of more DKA events, precision of the estimates continued to improve through analysis 9 [HR=2.95 (95% CI, 1.19-7.31)] in frail patients; [HR=1.77 (1.15, 2.75)] in non-frail patients], with sufficiently precise estimates by analysis 6 in frail patients [HR=2.80 (95% CI, 1.03, 7.61)] and by analysis 7 in non-frail patients [HR=1.62 (95% CI, 1.01, 2.57)].

scholarly journals Monitoring Utilization Trends of Glucose-Lowering Drugs for Type 2 Diabetes in Older Adults by Frailty Status

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 210-210
Author(s):  
Dae Kim ◽  
Alexander Kutz ◽  
Elisabetta Patorno ◽  
Chandrasekar Gopalakrishnan
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Fee For Service ◽  
Glucose Lowering ◽  
Frailty Status ◽  
Frail Patients ◽  
Lowering Drug ◽  
Service Data ◽  
Over Time

Abstract Using Medicare fee-for-service data from 2013-17, we identified a cohort of patients with type 2 diabetes (T2D) who initiated a glucose-lowering drug (mean [SD] age, 74.8 (6.9) years). Amongst frail patients (CFI≥0.20), metformin use remained stable from 29.1% to 29.4%, whereas sulfonylureas (25.8% to 22.1%) and insulin (21.2% to 19.0%) use declined. Amongst non-frail patients (CFI <0.20), metformin (35.3% to 33.1%) and sulfonylurea (26.2% to 22.2%) use decreased whereas insulin (11.7% to 10.6%) use remained stable. DPP-4i and glitazones use remained stable whereas the use of newer agents such as SGLT-2i and GLP-1 RA increased steadily over the study period in both frail and non-frail patients, though their use remains low ( <8%). In conclusion, sulfonylureas and insulin accounted for about one-third of initiated glucose-lowering medications and were more frequently used by frail patients, though their use declined steadily over time with the availability of newer agents.

scholarly journals Are there sex differences in the effect of type 2 diabetes in the incidence and outcomes of myocardial infarction? A matched-pair analysis using hospital discharge data

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Ana Lopez-de-Andres ◽  
Rodrigo Jimenez-Garcia ◽  
Valentin Hernández-Barrera ◽  
Jose M. de Miguel-Yanes ◽  
Romana Albaladejo-Vicente ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Sex Differences ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Hospital Discharge ◽  
St Elevation Myocardial Infarction ◽  
Men And Women ◽  
St Elevation

Abstract Background To analyze incidence, use of therapeutic procedures, and in-hospital outcomes in patients with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) according to the presence of type 2 diabetes (T2DM) in Spain (2016–2018) and to investigate sex differences. Methods Using the Spanish National Hospital Discharge Database, we estimated the incidence of myocardial infarctions (MI) in men and women with and without T2DM aged ≥ 40 years. We analyzed comorbidity, procedures, and outcomes. We matched each man and woman with T2DM with a non-T2DM man and woman of identical age, MI code, and year of hospitalization. Propensity score matching was used to compare men and women with T2DM. Results MI was coded in 109,759 men and 44,589 women (30.47% with T2DM). The adjusted incidence of STEMI (IRR 2.32; 95% CI 2.28–2.36) and NSTEMI (IRR 2.91; 95% CI 2.88–2.94) was higher in T2DM than non-T2DM patients, with higher IRRs for NSTEMI in both sexes. The incidence of STEMI and NSTEMI was higher in men with T2DM than in women with T2DM. After matching, percutaneous coronary intervention (PCI) was less frequent among T2DM men than non-T2DM men who had STEMI and NSTEMI. Women with T2DM and STEMI less frequently had a code for PCI that matched that of non-T2DM women. In-hospital mortality (IHM) was higher among T2DM women with STEMI and NSTEMI than in matched non-T2DM women. In men, IHM was higher only for NSTEMI. Propensity score matching showed higher use of PCI and coronary artery bypass graft and lower IHM among men with T2DM than women with T2DM for both STEMI and NSTEMI. Conclusions T2DM is associated with a higher incidence of STEMI and NSTEMI in both sexes. Men with T2DM had higher incidence rates of STEMI and NSTEMI than women with T2DM. Having T2DM increased the risk of IHM after STEMI and NSTEMI among women and among men only for NSTEMI. PCI appears to be less frequently used in T2DM patients After STEMI and NSTEMI, women with T2DM less frequently undergo revascularization procedures and have a higher mortality risk than T2DM men.

scholarly journals Risk of morbidity and mortality in patients with type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitor and/or dipeptidyl peptidase-4 inhibitor: a nationwide study

2021 ◽  
Vol 9 (1) ◽  
pp. e001765
Author(s):  
Gábor Sütő ◽  
Gergő A Molnár ◽  
Gyorgy Rokszin ◽  
Ibolya Fábián ◽  
Zoltan Kiss ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Dipeptidyl Peptidase ◽  
Dipeptidyl Peptidase 4 ◽  
Sodium Glucose Cotransporter ◽  
Dipeptidyl Peptidase 4 Inhibitor ◽  
All Cause Mortality

IntroductionMortality and disability in diabetes mellitus are determined mostly by cardiovascular complications and cancer. The impact of dipeptidyl peptidase-4 inhibitor (DPP-4i) and sodium-glucose cotransporter-2 inhibitor (SGLT2i) monotherapy or combination on long-term complications of type 2 diabetes mellitus was studied.Research design and methodsPatients with type 2 diabetes treated with DPP-4i or SGLT2i during a 3-year period were identified in the database of the National Institute of Health Insurance Fund in Hungary. All-cause mortality, acute myocardial infarction, stroke, hospitalization for heart failure (HHF), lower limb amputation (LLA) and cancer were assessed. Outcomes of add-on SGLT2i to DPP-4i treatment in comparison with switching DPP-4i therapy to SGLT2i were also evaluated. After propensity score matching, survival analysis was performed with a Cox proportional hazards model.ResultsAfter propensity score matching, both SGLT2i and DPP-4i groups included 18 583 patients. All-cause mortality (HR, 0.80; 95% CI 0.68 to 0.94; p=0.0057), HHF (HR, 0.81; 95% CI 0.71 to 0.92; p=0.0018), and risk of cancer (HR, 0.75; 95% CI 0.66 to 0.86; p<0.0001) were lower in the SGLT2i population compared with DPP-4i. Risk of LLA was higher in the SGLT2i group (HR, 1.35; 95% CI 1.03 to 1.77; p=0.0315). SGLT2i in combination with DPP-4i results in lower all-cause mortality (HR, 0.46; 95% CI 0.31 to 0.67; p=0.0001), with a lower trend in stroke, LLA, HHF and cancer, but without any statistical difference.ConclusionsSGLT2i treatment leads to a lower risk of overall mortality, HHF and cancer when compared with DPP-4i treatment. Adding SGLT2i to DPP-4i instead of switching from DPP-4i to SGLT2i further lowers the risk of all-cause mortality.

scholarly journals Risk of Dementia in Older Patients with Type 2 Diabetes on Dipeptidyl-Peptidase IV Inhibitors Versus Sulfonylureas: A Real-World Population-Based Cohort Study

2018 ◽  
Vol 8 (1) ◽  
pp. 28 ◽  
Author(s):  
Young-Gun Kim ◽  
Ja Jeon ◽  
Hae Kim ◽  
Dae Kim ◽  
Kwan-Woo Lee ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Real World ◽  
Lower Risk ◽  
Dipeptidyl Peptidase ◽  
Dipeptidyl Peptidase Iv ◽  
Dipeptidyl Peptidase Iv Inhibitors

Background: Type 2 diabetes is related to an increased risk of dementia. Preclinical studies of dipeptidyl peptidase-IV inhibitors (DPP-4i) for dementia have yielded promising results. Therefore, we investigated the risk of dementia in elderly patients with type 2 diabetes on DPP-4is and sulfonylureas (SU). Methods: Using a claims database called the Korean National Health Insurance Service Senior cohort, new users of DPP-4is and SUs were matched by 1:1 propensity score matching using 49 confounding variables (7552 new DPP-4is users and 7552 new SU users were matched by 1:1 propensity score matching; average age 75.4; mean follow-up period: 1361.9 days). Survival analysis was performed to estimate the risk of dementia. Results: The risk of all-cause dementia was lower in the DPP-4i group compared to the SU group (hazard ratio (HR) 0.66; 95% confidence interval (CI) 0.56–0.78; p < 0.001). Particularly, DPP-4i use showed a significantly lower risk of Alzheimer’s disease (HR 0.64; 95% CI 0.52–0.79; p < 0.001) and a lower risk, albeit non-significant, of vascular dementia compared to SU use (HR 0.66; 95% CI 0.38–1.14; p = 0.139). Conclusion: Our findings suggest that DPP-4i use decreases the risk of dementia compared to SU use in elderly patients with type 2 diabetes in a real-world clinical setting.

scholarly journals Comparison of Nearest Neighbor and Caliper Algorithms in Outcome Propensity Score Matching to Study the Relationship between Type 2 Diabetes and Coronary Artery Disease

2021 ◽  
Author(s):  
Sara Sabbaghian Tousi ◽  
Hamed Tabesh ◽  
Azadeh Saki ◽  
Ali Tagipour ◽  
Mohammad Tajfard
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Nearest Neighbor ◽  
Nearest Neighbor Algorithm ◽  
Artery Disease ◽  
The Relationship

Introduction: Propensity score matching (PSM) is a method to reduce the impact of essential and confounders. When the number of confounders is high, there may be a problem of matching, in which, finding matched pairs for the case group is difficult, or impossible. The propensity score (PS) minimizes the effect of the confounders, and it is reduced to one dimension. There are various algorithms in the field of PSM. This study aimed to compared the nearest neighbor and caliper algorithms. Methods: Data obtained in this study were from patients undergoing angiography at Ghaem Hospital in Mashhad, between 2011-12. The study was a retrospective case-control using PSM. In total, 604 patients were included in the case and control groups. A logistic regression model was used to calculate the propensity score and adjust the variables, such as age, gender, Body Mass Index (BMI), systolic blood pressure, smoking status, and triglyceride. Then, the Odds Ratios (ORs) with 95% Confidence Intervals (CIs) for the raw data and two matching algorithms were determined to examine the relationship between type 2 diabetes and coronary artery disease (CAD). Results: Propensity score in the nearest neighbor and caliper algorithms matched the total number of 604 samples, 200 and 178 pairs, respectively. All variables were significantly different between the two groups before matching (P<0.05). The gender was significantly different between the two groups after matching using the nearest neighbor algorithm (P=0.002). No variables created a significant difference between the two groups after matching with the caliper algorithm. Conclusion: Bias reduction in the caliper algorithm was greater than for the nearest neighbor algorithm for all variables except the triglyceride variable.

scholarly journals FRAILTY AND THE COMPARATIVE EFFECTIVENESS AND SAFETY OF SGLT2I AND GLP1-RA IN OLDER ADULTS WITH TYPE 2 DIABETES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S582-S582
Author(s):  
Elisabetta Patorno ◽  
Ajinkya Pawar ◽  
Seoyoung Kim ◽  
Dae Kim
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Comparative Effectiveness ◽  
Retrospective Cohort ◽  
Severe Hypoglycemia ◽  
Medicare Data ◽  
Frail Patients ◽  
Cardiovascular Endpoint

Abstract We conducted a 1:1 propensity score-matched retrospective cohort study of 87,218 patients with type 2 diabetes (mean age, 71.5 years [standard deviation, 5.1]) initiating a SGLT2i or a GLP1-RA in Medicare data. We estimated HRs (95% CIs) for a composite cardiovascular endpoint and severe hypoglycemia comparing the two treatments in the entire population and by the CFI-based frailty subgroups. Compared with GLP1-RA, SGLT2i were associated with similar rates of the composite cardiovascular endpoint (HR, 0.94 [95% CI, 0.86-1.03]) and severe hypoglycemia (0.87 [0.71-1.07]) over a mean follow-up of 8.6 months. The rate of composite cardiovascular endpoint was not meaningfully different between SGLT2i and GLP1-RA across non-frail (1.33 [0.80-2.23]), pre-frail (0.96 [0.85-1.08]), and frail patients (0.87 [0.73-1.04]). Similarly, the rate of severe hypoglycemia was not meaningfully different between the two treatments among non-frail (0.97 [0.20-4.80]), pre-frail (0.83 [0.64-1.08]), and frail patients (0.95 [0.67-1.34]).

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