Impact of oral antihyperglycemic therapy on all-cause mortality among patients with diabetes in the Veterans Health Administration

被引:44
作者
Kahler, Kristijan H.
Rajan, Mangala
Rhoads, George G.
Safford, Monca M.
Demissie, Kitaw
Lu, Shou-En
Pogach, Leonard M.
机构
[1] VA New Jersey Hlth Care Syst, Ctr Hlth Care knowledge & Management, E Orange, NJ USA
[2] Univ Med & Dent New Jersey, Sch Publ Hlth, Piscataway, NJ 08854 USA
[3] Birmingham VA Med Ctr, Deep S Ctr Effectiveness, Birmingham, AL USA
关键词
D O I
10.2337/dc06-2272
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE - The objective of this analysis was to evaluate the impact of several classes of oral antihyperglycemic therapy relative to sulfonylurea monotherapy on all-cause mortality among a cohort of patients with diabetes from the Veterans Health Administration (VHA). RESEARCH DESIGN AND METHODS - A retrospective cohort study using data obtained from the VHA Diabetes Epidemiology Cohort was used. Users of oral antihyperglycemic therapy were classified into the following cohorts: sulfonylurea monotherapy, metformin monotherapy, metformin plus sulfonylurea, thiazolidinedione (TZD) use alone or in combination with other oral agents (TZD users), and no drug therapy. All-cause mortality was the outcome of interest. Multivariate mixed models incorporating a propensity score to account for imbalance among cohorts were used to estimate drug effects on mortality with associated 95% ClS. RESULTS - A total of 39,721 patients with diabetes were included in the study. Adjusted odds ratios and 95% ClS for all-cause mortality were 0.87 (0.68-1.10) for metformin monotherapy users, 0.92 (0.82-1.05) for metformin plus sulfonylurea users, and 1.04 (0.75-1.46) for TZD users, relative to sulfonylurea monotherapy users. CONCLUSIONS - We did not find any significant drug effect on all-cause mortality for any oral treatment cohorts relative to sulfonylurea oral monotherapy.
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页码:1689 / 1693
页数:5
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