title: Durability of oral hypoglycemic agents in drug naïve patients with type 2 diabetes: report from the Swedish National Diabetes Register (NDR).
abstract: OBJECTIVE
  To analyze the durability of monotherapy with different classes of oral hypoglycemic agents (OHAs) in drug naïve patients with type 2 diabetes mellitus (T2DM) in real life.
  
  
  METHODS
  Men and women with T2DM, who were new users of OHA monotherapy and registered in the Swedish National Diabetes Register July 2005-December 2011, were available (n=17 309) and followed for up to 5.5 years. Time to monotherapy failure, defined as discontinuation of continuous use with the initial agent, switch to a new agent, or add-on treatment of a second agent, was analyzed as a measure of durability. Baseline characteristics were balanced by propensity score matching 1:5 between groups of sulfonylurea (SU) versus metformin (n=4303) and meglitinide versus metformin (n=1308). HRs with 95% CIs were calculated using Cox regression models.
  
  
  RESULTS
  SU and meglitinide, as compared with metformin, were associated with increased risk of monotherapy failure (HR 1.74; 95% CI 1.56 to 1.94 and 1.66; 1.37 to 2.00 for SU and meglitinide, respectively). When broken down by type of monotherapy failure, SU and meglitinide were associated with an increased risk of add-on treatment of a second agent (HR 3.14; 95% CI 2.66 to 3.69 and 2.52; 1.89 to 3.37 for SU and meglitinide, respectively) and of switch to a new agent (HR 2.81; 95% CI 2.01 to 3.92 and 3.78; 2.25 to 6.32 for SU and meglitinide, respectively). The risk of discontinuation did not differ significantly between the groups.
  
  
  CONCLUSIONS
  In this nationwide observational study reflecting clinical practice, SU and meglitinide showed substantially increased risk of switch to a new agent or add on of a second agent compared with metformin. These results indicate superior glycemic durability with metformin compared with SU and also meglitinide in real life.
authors: Department of Medicine , Sahlgrenska Academy, University of Gothenburg , Göteborg , Sweden.
authors: Nils
authors: N
authors: Ekström
authors: Centre of Registers in Region Västra Götaland , Göteborg , Sweden.
authors: Ann-Marie
authors: AM
authors: Svensson
authors: Centre of Registers in Region Västra Götaland , Göteborg , Sweden.
authors: Mervete
authors: M
authors: Miftaraj
authors: Department of Community Medicine and Public Health , University of Gothenburg , Göteborg , Sweden.
authors: Karolina
authors: K
authors: Andersson Sundell
authors: Department of Public Health and Caring Sciences/Family Medicine and Preventive Medicine , Uppsala University , Uppsala , Sweden.
authors: Jan
authors: J
authors: Cederholm
authors: Department of Public Health and Caring Sciences/Geriatrics , Uppsala University , Uppsala , Sweden ; Medical Products Agency , Uppsala , Sweden.
authors: Björn
authors: B
authors: Zethelius
authors: Department of Medicine , Sahlgrenska Academy, University of Gothenburg , Göteborg , Sweden.
authors: Björn
authors: B
authors: Eliasson
authors: Department of Medicine , Sahlgrenska Academy, University of Gothenburg , Göteborg , Sweden ; Centre of Registers in Region Västra Götaland , Göteborg , Sweden.
authors: Soffia
authors: S
authors: Gudbjörnsdottir
keywords: Oral Hypoglycaemic Agents; Pharmacoepidemiology; Type 2 Diabetes