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Glucose-lowering agents reduce 5-year survival
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The 5-year survival of patients on glucose-lowering agent differs and is partly driven by the patient’s individual risk profile.
The lowest 5-year mortality risk was found with metformin therapy, and statins were associated with lower 5-year mortality, according to the researchers.
Pieter Gillard, MD, PhD, of iMinds Medical IT, KU Leuven in Belgium, and colleagues evaluated data from the National Alliance of Christian Mutualities on 115,896 patients starting metformin, sulfonylurea or insulin (alone or in combination) between 2003 and 2007 to determine the effect of glucose-lowering agents on 5-year mortality. Patients not on glucose-lowering agents were matched for age, sex, history of cardiovascular events and therapy with antihypertensives, statins and blood platelet aggregation inhibitors with controls.
Glucose-lowering therapy groups included: metformin (n = 42,900), sulfonylurea (n = 19,231), insulin (n = 12,807), metformin and sulfonylurea (n = 25,218), metformin and insulin (n = 9,506), sulfonylurea and insulin (n = 6,087) and metformin, sulfonylurea and insulin (n = 10,653).
Excess mortality was highest in the group starting insulin (23.8%), followed by sulfonylurea (4.1%) and metformin (0.3%). A reduced 5-year survival compared with controls was found among participants on metformin plus sulfonylurea or metformin plus insulin and those on metformin, sulfonylurea and insulin.
In participants with a history of CV events, the lowest survival rates were found among those on therapies that involved both insulin and sulfonylurea. However, survival of participants with a history of CV events on metformin monotherapy did not significantly differ from the survival of matched controls.
Survival was highest in patients on metformin and lowered in those on sulfonylurea and insulin at any age. Survival was also lower in participants starting combination therapy compared with matched controls.
Participants using statins and glucose-lowering medications had higher survival regardless of CV history compared with participants not on statins.
“We conclude that 5-year survival in subjects on glucose-lowering therapy is lower than in matched controls except for metformin monotherapy,” the researchers wrote. “Intake of metformin is associated with lowest 5-year mortality. In all groups, the intake of statins was associated with a reduced mortality rate.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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