title: Cardiovascular drug use and hospitalizations attributable to type 2 diabetes.
abstract: OBJECTIVE
  To investigate cardiovascular drug use and hospitalizations attributable to type 2 diabetes from 1 year before until 6 years after the start of oral antidiabetic therapy.
  
  
  METHODS
  In this cohort study, 2,584 patients with type 2 diabetes were selected from the PHARMO Record Linkage System, comprising pharmacy records and hospitalizations for all 320,000 residents of six Dutch cities. Patients with type 2 diabetes were identified as incident oral antidiabetic drug users between 1992 and 1997. Nondiabetic subjects were 1:1-matched for age, sex, pharmacy, and index date and received no insulin, oral antidiabetic drugs, or glucose-testing supplies.
  
  
  RESULTS
  Patients with type 2 diabetes were more likely to use cardiovascular drugs (RR 1.28 [95% CI 1.23-1.34]) and to be hospitalized because of cardiovascular diseases (1.54 [1.33-1.78]) after the start of oral antidiabetic therapy than nondiabetic subjects. Differences between patients with type 2 diabetes and nondiabetic subjects lessened from 1 year before until 6 years after the start of oral antidiabetic therapy, reflected by decreasing attributable risks for diuretics, beta-blockers, calcium channel blockers, and cardiac and antithrombotic drugs. The difference in use of angiotensin-converting enzyme inhibitors and lipid-lowering drugs increased. Cardiovascular hospitalizations attributable to type 2 diabetes were approximately 50% in the years close to the start of oral antidiabetic treatment and decreased to approximately 33% in the following years.
  
  
  CONCLUSIONS
  Although cardiovascular drug use and hospitalizations remained increased in patients with type 2 diabetes after the start of oral antidiabetic therapy, cardiovascular drug use attributable to type 2 diabetes decreased after the start of oral antidiabetic therapy, especially beta-blockers, whereas cardiovascular hospitalizations first decreased and then stabilized.
authors.affiliation: Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht University, Utrecht, The Netherlands. j.a.erkens@pharm.uu.nl
authors.forename: J A
authors.initials: JA
authors.lastname: Erkens
authors.forename: O H
authors.initials: OH
authors.lastname: Klungel
authors.forename: R P
authors.initials: RP
authors.lastname: Stolk
authors.forename: J A
authors.initials: JA
authors.lastname: Spoelstra
authors.forename: D E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: H G
authors.initials: HG
authors.lastname: Leufkens
mesh_terms: D002317:Cardiovascular Agents / Q000145:classification / Q000627:therapeutic use*; D019992:Databases as Topic; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D004358:Drug Therapy / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009426:Netherlands; D010594:Pharmacies; D011996:Records
chemical_list: D002317:Cardiovascular Agents