title: Impact of oral antihyperglycemic therapy on all-cause mortality among patients with diabetes in the Veterans Health Administration.
abstract: OBJECTIVE
  The objective of this analysis was to evaluate the impact of several classes of oral antihyperglycemic therapy relative to sulfonylurea monotherapy on all-cause mortality among a cohort of patients with diabetes from the Veterans Health Administration (VHA).
  
  
  METHODS
  A retrospective cohort study using data obtained from the VHA Diabetes Epidemiology Cohort was used. Users of oral antihyperglycemic therapy were classified into the following cohorts: sulfonylurea monotherapy, metformin monotherapy, metformin plus sulfonylurea, thiazolidinedione (TZD) use alone or in combination with other oral agents (TZD users), and no drug therapy. All-cause mortality was the outcome of interest. Multivariate mixed models incorporating a propensity score to account for imbalance among cohorts were used to estimate drug effects on mortality with associated 95% CIs.
  
  
  RESULTS
  A total of 39,721 patients with diabetes were included in the study. Adjusted odds ratios and 95% CIs for all-cause mortality were 0.87 (0.68-1.10) for metformin monotherapy users, 0.92 (0.82-1.05) for metformin plus sulfonylurea users, and 1.04 (0.75-1.46) for TZD users, relative to sulfonylurea monotherapy users.
  
  
  CONCLUSIONS
  We did not find any significant drug effect on all-cause mortality for any oral treatment cohorts relative to sulfonylurea oral monotherapy.
authors: Center for Health Care Knowledge and Management, VA New Jersey Health Care System, East Orange, New Jersey, USA. kristijan.kahler@novartis.com
authors: Kristijan H
authors: KH
authors: Kahler
authors: Mangala
authors: M
authors: Rajan
authors: George G
authors: GG
authors: Rhoads
authors: Monika M
authors: MM
authors: Safford
authors: Kitaw
authors: K
authors: Demissie
authors: Shou-En
authors: SE
authors: Lu
authors: Leonard M
authors: LM
authors: Pogach
mesh_terms: D000284:Administration, Oral; D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000401:mortality*; D004359:Drug Therapy, Combination; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008297:Male; D008687:Metformin / Q000008:administration & dosage; D008875:Middle Aged; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000008:administration & dosage; D045162:Thiazolidinediones / Q000008:administration & dosage
chemical_list: D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; D008687:Metformin