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The risk of overall mortality in patients with type 2 diabetes receiving glipizide, glyburide, or glimepiride monotherapy: a retrospective analysis.

Pantalone KM, Kattan MW, Yu C, Wells BJ, Arrigain S, Jain A, Atreja A, Zimmerman RS - Diabetes Care (2010)

Bottom Line: Multivariable Cox models were used to compare cohorts.No statistically significant difference in the risk of overall mortality was observed among these agents in the entire cohort, but we did find evidence of a trend toward an increased overall mortality risk with glyburide versus glimepiride (hazard ratio 1.36 [95% CI 0.96-1.91]) and glipizide versus glimepiride (1.39 [0.99-1.96]) in those with documented CAD.Our results did not identify an increased mortality risk among the individual sulfonylureas but did suggest that glimepiride may be the preferred sulfonylurea in those with underlying CAD.

View Article: PubMed Central - PubMed

Affiliation: Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA. pantalk@ccf.org

ABSTRACT

Objective: Sulfonylureas have historically been analyzed as a medication class, which may be inappropriate given the differences in properties inherent to the individual sulfonylureas (hypoglycemic risk, sulfonylurea receptor selectivity, and effects on myocardial ischemic preconditioning). The purpose of this study was to assess the relationship of individual sulfonylureas and the risk of overall mortality in a large cohort of patients with type 2 diabetes.

Research design and methods: A retrospective cohort study was conducted using an academic health center enterprise-wide electronic health record (EHR) system to identify 11,141 patients with type 2 diabetes (4,279 initiators of monotherapy with glyburide, 4,325 initiators of monotherapy with glipizide, and 2,537 initiators of monotherapy with glimepiride), >or=18 years of age with and without a history of coronary artery disease (CAD) and not on insulin or a noninsulin injectable at baseline. The patients were followed for mortality by documentation in the EHR and Social Security Death Index. Multivariable Cox models were used to compare cohorts.

Results: No statistically significant difference in the risk of overall mortality was observed among these agents in the entire cohort, but we did find evidence of a trend toward an increased overall mortality risk with glyburide versus glimepiride (hazard ratio 1.36 [95% CI 0.96-1.91]) and glipizide versus glimepiride (1.39 [0.99-1.96]) in those with documented CAD.

Conclusions: Our results did not identify an increased mortality risk among the individual sulfonylureas but did suggest that glimepiride may be the preferred sulfonylurea in those with underlying CAD.

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Related in: MedlinePlus

Overall mortality in the entire cohort (A) and subgroup with a documented history of CAD (B), treated with sulfonylurea monotherapy. The decreasing numbers of patients at risk for mortality are secondary to the staggered entry of the study subjects, not loss to follow-up. The final status of all patients was ascertained via the SSDI.
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Figure 1: Overall mortality in the entire cohort (A) and subgroup with a documented history of CAD (B), treated with sulfonylurea monotherapy. The decreasing numbers of patients at risk for mortality are secondary to the staggered entry of the study subjects, not loss to follow-up. The final status of all patients was ascertained via the SSDI.

Mentions: The cohorts contained a total of 1,921 mortality events in the entire cohort (n = 11,141) and 322 in the subgroup with a history of documented CAD (n = 1,505). The survival curves for mortality, for both the entire cohort and for the subgroup with a documented history of CAD, can be seen in Fig. 1. There were 1,753 patients lost to follow-up in the EHR but with vital status from the SSDI. The median follow-up was 2.4 years. The hazard ratios with 95% CIs for the sulfonylurea monotherapy comparisons for mortality in the entire cohort, and the subgroup with documented CAD, can be seen in Table 3, after adjusting for baseline variables.


The risk of overall mortality in patients with type 2 diabetes receiving glipizide, glyburide, or glimepiride monotherapy: a retrospective analysis.

Pantalone KM, Kattan MW, Yu C, Wells BJ, Arrigain S, Jain A, Atreja A, Zimmerman RS - Diabetes Care (2010)

Overall mortality in the entire cohort (A) and subgroup with a documented history of CAD (B), treated with sulfonylurea monotherapy. The decreasing numbers of patients at risk for mortality are secondary to the staggered entry of the study subjects, not loss to follow-up. The final status of all patients was ascertained via the SSDI.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2875427&req=5

Figure 1: Overall mortality in the entire cohort (A) and subgroup with a documented history of CAD (B), treated with sulfonylurea monotherapy. The decreasing numbers of patients at risk for mortality are secondary to the staggered entry of the study subjects, not loss to follow-up. The final status of all patients was ascertained via the SSDI.
Mentions: The cohorts contained a total of 1,921 mortality events in the entire cohort (n = 11,141) and 322 in the subgroup with a history of documented CAD (n = 1,505). The survival curves for mortality, for both the entire cohort and for the subgroup with a documented history of CAD, can be seen in Fig. 1. There were 1,753 patients lost to follow-up in the EHR but with vital status from the SSDI. The median follow-up was 2.4 years. The hazard ratios with 95% CIs for the sulfonylurea monotherapy comparisons for mortality in the entire cohort, and the subgroup with documented CAD, can be seen in Table 3, after adjusting for baseline variables.

Bottom Line: Multivariable Cox models were used to compare cohorts.No statistically significant difference in the risk of overall mortality was observed among these agents in the entire cohort, but we did find evidence of a trend toward an increased overall mortality risk with glyburide versus glimepiride (hazard ratio 1.36 [95% CI 0.96-1.91]) and glipizide versus glimepiride (1.39 [0.99-1.96]) in those with documented CAD.Our results did not identify an increased mortality risk among the individual sulfonylureas but did suggest that glimepiride may be the preferred sulfonylurea in those with underlying CAD.

View Article: PubMed Central - PubMed

Affiliation: Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA. pantalk@ccf.org

ABSTRACT

Objective: Sulfonylureas have historically been analyzed as a medication class, which may be inappropriate given the differences in properties inherent to the individual sulfonylureas (hypoglycemic risk, sulfonylurea receptor selectivity, and effects on myocardial ischemic preconditioning). The purpose of this study was to assess the relationship of individual sulfonylureas and the risk of overall mortality in a large cohort of patients with type 2 diabetes.

Research design and methods: A retrospective cohort study was conducted using an academic health center enterprise-wide electronic health record (EHR) system to identify 11,141 patients with type 2 diabetes (4,279 initiators of monotherapy with glyburide, 4,325 initiators of monotherapy with glipizide, and 2,537 initiators of monotherapy with glimepiride), >or=18 years of age with and without a history of coronary artery disease (CAD) and not on insulin or a noninsulin injectable at baseline. The patients were followed for mortality by documentation in the EHR and Social Security Death Index. Multivariable Cox models were used to compare cohorts.

Results: No statistically significant difference in the risk of overall mortality was observed among these agents in the entire cohort, but we did find evidence of a trend toward an increased overall mortality risk with glyburide versus glimepiride (hazard ratio 1.36 [95% CI 0.96-1.91]) and glipizide versus glimepiride (1.39 [0.99-1.96]) in those with documented CAD.

Conclusions: Our results did not identify an increased mortality risk among the individual sulfonylureas but did suggest that glimepiride may be the preferred sulfonylurea in those with underlying CAD.

Show MeSH
Related in: MedlinePlus