title: Progression to insulin therapy among patients with type 2 diabetes treated with sitagliptin or sulphonylurea plus metformin dual therapy.
abstract: OBJECTIVE
  To assess time to insulin initiation among patients with type 2 diabetes mellitus (T2DM) treated with sitagliptin versus sulphonylurea as add-on to metformin.
  
  
  METHODS
  This retrospective cohort study used GE Centricity electronic medical records and included patients aged ≥18 years with continuous medical records and an initial prescription of sitagliptin or sulphonylurea (index date) with metformin for ≥90 days during 2006-2013. Sitagliptin and sulphonylurea users were matched 1 : 1 using propensity score matching, and differences in insulin initiation were assessed using Kaplan-Meier curves and Cox regression. We used conditional logistic regression to examine the likelihood of insulin use 1-6 years after the index date for each year.
  
  
  RESULTS
  Propensity score matching produced 3864 matched pairs. Kaplan-Meier analysis showed that sitagliptin users had a lower risk of insulin initiation compared with sulphonylurea users (p = 0.003), with 26.6% of sitagliptin users initiating insulin versus 34.1% of sulphonylurea users over 6 years. This finding remained significant after adjusting for baseline characteristics (hazard ratio 0.76, 95% confidence interval 0.65-0.90). Conditional logistic regression analyses confirmed that sitagliptin users were less likely to initiate insulin compared with sulphonylurea users [odds ratios for years 1-6: 0.77, 0.79, 0.81, 0.57, 0.29 and 0.75, respectively (p < 0.05 for years 4 and 5)].
  
  
  CONCLUSIONS
  In this real-world matched cohort study, patients with T2DM treated with sitagliptin had a significantly lower risk of insulin initiation compared with patients treated with sulphonylurea, both as add-on to metformin.
authors.affiliation: Section of Endocrinology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Inzucchi
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: K
authors.initials: K
authors.lastname: Tunceli
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Qiu
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: S
authors.initials: S
authors.lastname: Rajpathak
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: K G
authors.initials: KG
authors.lastname: Brodovicz
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Engel
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: P
authors.initials: P
authors.lastname: Mavros
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: L
authors.initials: L
authors.lastname: Radican
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: P
authors.initials: P
authors.lastname: Brudi
authors.affiliation: Asclepius Analytics LLC, New York, NY, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Li
authors.affiliation: Asclepius Analytics LLC, New York, NY, USA.
authors.forename: C P S
authors.initials: CP
authors.lastname: Fan
authors.affiliation: Asclepius Analytics LLC, New York, NY, USA.
authors.forename: B
authors.initials: B
authors.lastname: Hanna
authors.affiliation: Asclepius Analytics LLC, New York, NY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Tang
authors.affiliation: Ochsner Medical Center, New Orleans, LA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Blonde
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004334:Drug Administration Schedule; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D053208:Kaplan-Meier Estimate; D008297:Male; D008687:Metformin / Q000008:administration & dosage*; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D000068900:Sitagliptin Phosphate / Q000008:administration & dosage*; D013453:Sulfonylurea Compounds / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D008687:Metformin; D000068900:Sitagliptin Phosphate
keywords: DPP-IV inhibitor; database research; insulin therapy; sulphonylureas; type 2 diabetes