Impact of Oral Antihyperglycemic Therapy on All-Cause Mortality Among Patients With Diabetes in the Veterans Health Administration

• Published in: Diabetes care Vol. 30; no. 7; pp. 1689 - 1693
• Main Authors: Kahler, Kristijan H, Rajan, Mangala, Rhoads, George G, Safford, Monika M, Demissie, Kitaw, Lu, Shou-En, Pogach, Leonard M
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-07-2007
• Subjects: Administration, Oral; Aged; Biological and medical sciences; Cohort Studies; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - mortality; Diabetes. Impaired glucose tolerance; Dosage and administration; Drug therapy; Drug Therapy, Combination; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Hospitals, Veterans; Humans; Hypoglycemic agents; Hypoglycemic Agents - administration & dosage; Male; Medical sciences; Metformin - administration & dosage; Middle Aged; Mortality; Retrospective Studies; Risk factors; Studies; Sulfonylurea Compounds - administration & dosage; Thiazolidinediones - administration & dosage; United States; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; United States; North America; America; Endocrinopathy; Human; Therapy; Nutrition; Diabetes mellitus; Mortality; Oral administration; Patient; Metabolic diseases; Epidemiology; Hypoglycemic agent; Treatment; Cause; Veteran; Endocrinology
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc06-2272

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% CIs. RESULTS:-- A total of 39,721 patients with diabetes were included in the study. Adjusted odds ratios and 95% CIs 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.