Cardiovascular events and mortality among type 2 diabetes mellitus patients newly prescribed first-line blood glucose-lowering drugs monotherapies: A population-based cohort study in the Catalan electronic medical record database, SIDIAP, 2010-2015.

Abstract Aim To assess cardiovascular (CV) events and all-cause mortality in type 2 diabetes mellitus (T2DM) patients treated with first-line monotherapies of non-insulin antidiabetic drugs (NIADs). Methods Longitudinal retrospective cohort study in the Catalan database SIDIAP (Information System for the Development of Research in Primary Care). T2DM patients ≥18 years newly prescribed first-line monotherapies during 2010–2015 were followed since their first prescription until the composite of major adverse CV events, MACE (myocardium infarction [MI], stroke and all-cause death), its components, heart failure (HF) and peripheral artery disease (PAD) or censoring. Cox proportional hazard models were used to estimate hazard ratios 95% confidence interval (HR [95%CI]). Results Compared with metformin, the use of sulfonylureas, dipeptidyl peptidase-4 inhibitors (DPP-4 i) and meglitinides were significantly associated with higher risk for MACE (1.55 [1.42–1.68]); 1.49 [1.22−1.84] and 2.01 [1.29−3.12]) and all-cause mortality (1.67 [1.52–1.84], 1.65 [1.30−2.] and 2.08 [1.26−3.42]). Sulfonylureas users had increased risk of MI (1.38 [1.03–1.85]) stroke (1.31 [1.11–1.54]), HF (1.49 [1.28−1.72]) and PAD (1.24 [1.02−1.51]). Meglitinides users were at increased risks of MI, HR 2.03 (1.10−3.74). Conclusion In first-line monotherapies, compared with metformin, sulfonylureas were associated with increased risks in all the outcomes; DPP-4 i and repaglinide showed increased risks of MACE and mortality. Residual confounding cannot be ruled out.