Benefit Class of Second-line Anti-diabetic Medication on Types of Dementia in Type 2 Diabetes: A Nationwide Real-world Longitudinal Study

Abstract BackgroundTo investigate the association between treatment of anti-diabetic agents and dementia in type 2 diabetes mellitus using an extensive dataset from the Korean National Health Insurance System and Health Screenings. MethodsAfter excluding anyone younger than 40, those taking no anti-diabetic medications within 1 yr of the examination, anyone diagnosed with dementia before the examination or its development within 1 yr of the examination, and those with missing data, 1,578,322 individuals with diabetes prescribed an anti-diabetic agent (metformin (Met), sulfonylurea (SU), thiazolidinedione (TZD), dipeptidyl peptidase-4 inhibitor (DPP-4i), meglitinide (Megl), alpha-glucosidase inhibitor(AGI) and/or insulin) between 2009 and 2012 were identified from the Korean National Health Insurance Service Database, where 701,193 individuals taking oral dual therapy were tracked until 2017. All-cause, Alzheimer’s (AD) and vascular dementia (VaD) were investigated by oral dual therapy. Adjustments were made for age, sex, income, diabetes duration, hypertension, dyslipidaemia, smoking, drinking, exercise, BMI, glucose level and estimated glomerular filtration rate. Results Compared with dual therapy with Met + SU, dual therapy with Met + DPP-4i, Met + TZD, and SU + TZD, was associated with lower all-cause dementia (HR (95% CI) = 0.904 (0.879-0.929), 0.804 (0.767-0.844), and 0.962 (0.929-0.996), respectively) and VaD (HR (95% CI) = 0.865 (0.806-0.928), 0.725 (0.64-0.822), and 0.911 (0.833-0.995), respectively) after adjustment. Also, compared with the group treated with Met + SU, those treated with Met + DPP-4i and Met + TZD were associated with a significantly lower risk of AD (HR (95% CI) = 0.922 (0.894-0.951) and 0.812 (0.77-0.857)) except for SU + TZD (HR (95% CI) = 0.971 (0.934-1.01)). Dual therapy with TZD was associated with a significantly lower risk of all-cause dementia, AD, and VaD than nonusers of TZD (HR (95% CI) = 0.918 (0.892-0.944), 0.925 (0.896-0.955) and 0.859 (0.798-0.924), respectively). Conclusions Adding TZD or DPP-4i instead of SU as second-line treatment in combination with first-line Met may be considered for delaying or preventing dementia. Also, TZD users relative to TZD non-users on dual therapy had a significantly lower risk of all types of dementia.

Download Full-text

The Association Between Second-Line Oral Antihyperglycemic Medication on Types of Dementia in Type 2 Diabetes: A Nationwide Real-World Longitudinal Study

Journal of Alzheimer s Disease ◽

10.3233/jad-201535 ◽

2021 ◽

pp. 1-10

Author(s):

Won Jun Kim ◽

Jung Hyun Noh ◽

Kyungdo Han ◽

Cheol-Young Park

Keyword(s):

Type 2 Diabetes ◽

Health Insurance ◽

National Health Insurance ◽

National Health ◽

Lower Risk ◽

Oral Therapy ◽

Dual Therapy ◽

Second Line ◽

Korean National Health Insurance

Background: There are few reports that evaluated the association between various types of dementia and dual oral therapy with antihyperglycemic medication. Objective: The goal of this study was to investigate the association between treatment of dual antihyperglycemic medication and dementia subclass in type 2 diabetes mellitus using the Korean National Health Insurance System. Methods: This study included 701,193 individuals with diabetes prescribed dual oral therapy between 2009 and 2012 from the Korean National Health Insurance Service Database, which were tracked until 2017. All-cause, Alzheimer’s (AD) and vascular dementia (VaD) were investigated by dual oral therapy. Adjustments were made for age, sex, income, diabetes duration, hypertension, dyslipidemia, smoking, drinking, exercise, body mass index, glucose level, and estimated glomerular filtration rate. Results: Dual therapy with metformin (Met) + dipeptidyl peptidase-4 inhibitor (DPP-4i), Met + thiazolidinedione (TZD), and sulfonylurea (SU) + thiazolidinediones (TZD) were significantly associated with all-cause dementia (HR = 0.904, 0.804, and 0.962, respectively) and VaD (HR = 0.865, 0.725, and 0.911, respectively), compared with Met + SU. Met + DPP-4i and Met + TZD were associated with significantly lower risk of AD (HR = 0.922 and 0.812), compared with Met + SU. Dual therapy with TZD was associated with a significantly lower risk of all-cause dementia, AD, and VaD than nonusers of TZD (HR = 0.918, 0.925 and 0.859, respectively). Conclusion: Adding TZD or DPP-4i instead of SU as second-line anti-diabetic treatment may be considered for delaying or preventing dementia. Also, TZD users relative to TZD non-users on dual oral therapy were significantly associated with lower risk of various types of dementia.

Download Full-text

Fenofibrate Use Is Associated With Lower Mortality and Fewer Cardiovascular Events in Patients With Diabetes: Results of 10,114 Patients From the Korean National Health Insurance Service Cohort

10.2337/figshare.14597091.v1 ◽

2021 ◽

Author(s):

Sang-Ho Jo ◽

Hyewon Nam ◽

Jeongwoo Lee ◽

Sojeong Park ◽

Jungkuk Lee ◽

...

Keyword(s):

Type 2 Diabetes ◽

Health Insurance ◽

National Health Insurance ◽

National Health ◽

Primary Endpoint ◽

Cardiac Death ◽

Cardiovascular Events ◽

Coronary Revascularization ◽

Korean National Health Insurance

Objective: We investigate long term clinical efficacy of fenofibrate use on mortality and cardiovascular outcomes in patients with type 2 diabetes. Research design and Methods: We performed population based cohort study using data of Korean National Health Insurance from 2003 to 2014. Among 63727 participants with diabetes aged 40-79, 5057 users of fenofibrate only were compared with 5057 non-users of fenofibrate and/or omega-3 fatty acid with 1:1 propensity matching. Primary endpoint was composite of myocardial infarction, stroke, percutaneous coronary revascularization and cardiac death for median 3 years. Results: Primary endpoint was significantly lower in fenofibrate users as compared to neither users, 13.4 vs. 15.5 per 1000 person years (hazard ratio [HR] 0.76, confidence interval [CI], 0.62-0.94, P=0.010). Cardiac death (1.8 vs. 3.1 per 1000 person years [HR 0.59, CI, 0.352- 0.987, p=0.0446]), all cause death (7.6 vs. 15.3 per 1000 person years [HR 0.437, CI, 0.340 -0.562, p<0.0001]), and stroke (6.5 vs. 8.6 per 1000 person years [HR 0.621, CI, 0.463-0.833, P=0.0015]) were significantly lower in fenofibrate group. As the duration of fenofibrate use stratified by quartiles (Q1-4), the risk decreased in Q4 with HR of 0.347 (95% CI 0.226-0.532, P<0.0001). In subgroup analysis, the favoring effect of fenofibrate is sustained consistently across all subset of patients including those classified by LDL-C, HDL-C and TG levels. Conclusions: Use of fenofibrate was associated with lower rate of total and cardiac mortality and cardiovascular events in type 2 diabetes patients for 3 year follow-up in real world large populations.

Download Full-text