Diabetes, obesity & metabolism 2017 04 21() doi 10.1111/dom.12979
Heart failure (HF) is frequent in type 2 diabetes (T2D) and several glucose-lowering medications may increase HF risk. In the SAVOR-TIMI trial, patients on Saxagliptin experienced a 27% higher risk of hospitalisation for HF (HHF). In a retrospective study on 127,555 patients, we showed that DPP-4i therapy was associated with a lower HHF risk than sulphonylurea (SU) therapy. We herein re-analyzed such data to evaluate intraclass differences among DPP-4i and SU.
MATERIALS AND METHODS
We included T2D patients initiating DPP-4i or SU alone or in combination with metformin. Patients undergoing intraclass switch, those with a previous HHF, insulin treatment, or <6 months observation were excluded. We calculated incidence of first and total HHF events / 1000 person-year. Cox proportional hazard and Poisson multiple regression models, as well as propensity matching, were used to account for baseline confounders. RESULTS
The analysis included 17,615 DPP-4i users (60.1% Sitagliptin; 27.0% Vildagliptin; 12.9% Saxagliptin) and 86,734 SU users (37.5% Glibenclamide; 34.6% Glimepiride; 27.9% Gliclazide). No intraclass difference in the incidence rate of first and total HHF events was noted among the 3 DPP-4i and among the 3 SU. Multivariable adjustments for baseline confounders or propensity matching did not change the results. No intraclass difference in HHF risk was observed also in patients at higher cardiovascular risk.
In a cohort of T2D patients from about one third of the Italian population, no intraclass difference was noted for DPP-4i and SU with regards to HHF risk.