title: 14-Year risk of all-cause mortality according to hypoglycaemic drug exposure in a general population.
abstract: OBJECTIVE
  Guidelines for management of patients with type 2 diabetes mellitus recommend the use of hypoglycaemic drugs when lifestyle interventions remain insufficient for glycaemic control. Recent trials have provided worrying safety data on certain hypoglycaemic drugs. The aim of this study was to assess 14-year risk of all-cause mortality according to hypoglycaemic drug exposure at baseline, in a general population.
  
  
  METHODS
  Our analysis was based on the observational Third French MONICA survey on cardiovascular risk factors (1995-1997). Vital status was obtained 14 years after inclusion, and assessment of determinants of mortality was based on multivariable Cox modelling.
  
  
  RESULTS
  There were 3336 participants and 248 deaths over the 14-year period. At baseline, there were 3162 (95%) non-diabetic, 46 (1%) untreated type 2 diabetic and 128 (4%) type 2 diabetic subjects with hypoglycaemic drug treatment (metformin alone (31%), sulfonylureas alone or in combination (49%), insulin alone or in combination (10%), or other treatments (9%)). After adjustment for duration of diabetes, history of diabetes complications, area of residence (centre), age, gender, educational level, alcohol consumption, smoking, blood pressure, LDL and HDL cholesterol, which all were significant and independent determinants of mortality, the hazard ratio for all-cause mortality was 3.22 [95% confidence interval: 0.87-11.9] for untreated diabetic subjects, 2.28 [0.98-5.26] for diabetics treated with metformin alone, 1.70 [0.92-3.16] for diabetics with sulfonylureas and 4.92 [1.70-14.3] for diabetic with insulin versus non-diabetic subjects.
  
  
  CONCLUSIONS
  Our results support the conclusion that until more evidence is provided from randomized trials, a prudent approach should be to restrain use of insulin to situations in which combinations of non-insulin agents have failed to appropriately achieve glycemic control, as it is recommended in the current guidelines for the management of type 2 diabetes.
authors.affiliation: Department of Epidemiology, Health Economics and Public Health, UMR-1027 INSERM, Toulouse University School of Medicine, Toulouse University Hospital, Toulouse, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Bérard
authors.affiliation: Department of Epidemiology, Health Economics and Public Health, UMR-1027 INSERM, Toulouse University School of Medicine, Toulouse University Hospital, Toulouse, France.
authors.forename: Vanina
authors.initials: V
authors.lastname: Bongard
authors.affiliation: Department of Epidemiology and Public Health, U-744 INSERM, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Dallongeville
authors.affiliation: Department of Epidemiology and Public Health, EA 3430, Université de Strasbourg, Faculté de Médecine, Strasbourg, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Arveiler
authors.affiliation: Department of Epidemiology and Public Health, U-744 INSERM, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Cottel
authors.affiliation: Department of Epidemiology and Public Health, EA 3430, Université de Strasbourg, Faculté de Médecine, Strasbourg, France.
authors.forename: Aline
authors.initials: A
authors.lastname: Wagner
authors.affiliation: Department of Epidemiology, Health Economics and Public Health, UMR-1027 INSERM, Toulouse University School of Medicine, Toulouse University Hospital, Toulouse, France.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Ruidavets
authors.affiliation: Department of Epidemiology, Health Economics and Public Health, UMR-1027 INSERM, Toulouse University School of Medicine, Toulouse University Hospital, Toulouse, France; Department of Cardiology B, Toulouse University Hospital, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D007004:Hypoglycemic Agents
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