title: The effect of incident antidiabetic regimens on lipid profiles in veterans with type 2 diabetes: a retrospective cohort.
abstract: OBJECTIVE
  Effects of oral antidiabetic drugs (OADs) on lipids may influence cardiovascular outcomes. Our aim was to compare time to initiation of lipid lowering medication (LLM) and 12-month lipid profiles among new OAD users.
  
  
  METHODS
  We identified a retrospective cohort of 17,774 veterans who received care at Veterans Administration (VA) Mid-South Network with a first OAD from 1 January 2000 to 31 December 2007. There were 6917 patients (38.9%) not on a LLM at baseline, and 3871 (56%) had complete covariates. Incident users of sulfonylurea and combination metformin + sulfonylurea were compared to metformin users for time to LLM initiation. Incident users of these OADs and thiazolidendiones were included in comparison of 12-month low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TGs), and total cholesterol. All analyses adjusted for demographics, lipids, HbA1C, healthcare utilization, and cardiovascular disease at baseline.
  
  
  RESULTS
  The median time to starting LLM was 2.35 years (interquartile range 0.96, 4.6) following metformin initiation and not statistically different for users of sulfonylureas, or combination OADs. Compared to metformin users, 12-month HDL was 1.35 mg/dl (95%CI: -2.01, -0.72) lower and TGs were 5.7% higher (95%CI: 1.5%, 10.0%) for sulfonylurea users; TGs were 24.8% (95%CI: 0.7%, 54.5%) higher for thiazolidinedione users. Statin users had LDL and total cholesterol 16.7 mg/dl (95%CI: -19.9, -13.5) and 18.6 mg/dl (95%CI: -22.1, -15.1) lower than non-statin users, respectively.
  
  
  CONCLUSIONS
  Time to LLM initiation was similar between OADs. Metformin use resulted in more favorable lipids at 12 months compared to sulfonylureas or thiazolidinediones.
authors.affiliation: VA Tennessee Valley Geriatric Research Education Clinical Center, HSR&D Targeted Research Enhancement Program for Patient Healthcare Behavior, Clinical Research Center of Excellence, Nashville, TN, USA. christianne.roumie@vanderbilt.edu
authors.forename: Christianne L
authors.initials: CL
authors.lastname: Roumie
authors.forename: Mary Margaret
authors.initials: MM
authors.lastname: Huizinga
authors.forename: Xulei
authors.initials: X
authors.lastname: Liu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Greevy
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Grijalva
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Murff
authors.forename: Adriana M
authors.initials: AM
authors.lastname: Hung
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000139:chemically induced; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004347:Drug Interactions; D050171:Dyslipidemias / Q000139:chemically induced; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D050356:Lipid Metabolism / Q000187:drug effects*; D008055:Lipids / Q000097:blood*; D008297:Male; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D045162:Thiazolidinediones / Q000627:therapeutic use; D016896:Treatment Outcome; D014728:Veterans
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D008055:Lipids; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones