title: Comparative effectiveness of sulfonylurea and metformin monotherapy on cardiovascular events in type 2 diabetes mellitus: a cohort study.
abstract: BACKGROUND
  The effects of sulfonylureas and metformin on outcomes of cardiovascular disease (CVD) in type 2 diabetes are not well-characterized.
  
  
  OBJECTIVE
  To compare the effects of sulfonylureas and metformin on CVD outcomes (acute myocardial infarction and stroke) or death.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  National Veterans Health Administration databases linked to Medicare files.
  
  
  METHODS
  Veterans who initiated metformin or sulfonylurea therapy for diabetes. Patients with chronic kidney disease or serious medical illness were excluded.
  
  
  METHODS
  Composite outcome of hospitalization for acute myocardial infarction or stroke, or death, adjusted for baseline demographic characteristics; medications; cholesterol, hemoglobin A1c, and serum creatinine levels; blood pressure; body mass index; health care utilization; and comorbid conditions.
  
  
  RESULTS
  Among 253 690 patients initiating treatment (98 665 with sulfonylurea therapy and 155 025 with metformin therapy), crude rates of the composite outcome were 18.2 per 1000 person-years in sulfonylurea users and 10.4 per 1000 person-years in metformin users (adjusted incidence rate difference, 2.2 [95% CI, 1.4 to 3.0] more CVD events with sulfonylureas per 1000 person-years; adjusted hazard ratio [aHR], 1.21 [CI, 1.13 to 1.30]). Results were consistent for both glyburide (aHR, 1.26 [CI, 1.16 to 1.37]) and glipizide (aHR, 1.15 [CI, 1.06 to 1.26]) in subgroups by CVD history, age, body mass index, and albuminuria; in a propensity score-matched cohort analysis; and in sensitivity analyses.
  
  
  CONCLUSIONS
  Most of the veterans in the study population were white men; data on women and minority groups were limited but reflective of the Veterans Health Administration population.
  
  
  CONCLUSIONS
  Use of sulfonylureas compared with metformin for initial treatment of diabetes was associated with an increased hazard of CVD events or death.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality and the U.S. Department of Health and Human Services.
authors.affiliation: Veterans Affairs Tennessee Valley Healthcare System, 1310 24th Avenue South, Geriatric Research Education Clinical Center, Nashville, TN 37212, USA. christianne.roumie@vanderbilt.edu
authors.forename: Christianne L
authors.initials: CL
authors.lastname: Roumie
authors.forename: Adriana M
authors.initials: AM
authors.lastname: Hung
authors.forename: Robert A
authors.initials: RA
authors.lastname: Greevy
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Grijalva
authors.forename: Xulei
authors.initials: X
authors.lastname: Liu
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Murff
authors.forename: Tom A
authors.initials: TA
authors.lastname: Elasy
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
mesh_terms: D000368:Aged; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008687:Metformin / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D008687:Metformin