title: Risk of hospitalization for heart failure in patients with type 2 diabetes newly treated with DPP-4 inhibitors or other oral glucose-lowering medications: a retrospective registry study on 127,555 patients from the Nationwide OsMed Health-DB Database.
abstract: OBJECTIVE
  Oral glucose-lowering medications are associated with excess risk of heart failure (HF). Given the absence of comparative data among drug classes, we performed a retrospective study in 32 Health Services of 16 Italian regions accounting for a population of 18 million individuals, to assess the association between HF risk and use of sulphonylureas, DPP-4i, and glitazones.
  
  
  RESULTS
  We extracted data on patients with type 2 diabetes who initiated treatment with DPP-4i, thiazolidinediones, or sulphonylureas alone or in combination with metformin during an accrual time of 2 years. The endpoint was hospitalization for HF (HHF) occurring after the first 6 months of therapy, and the observation was extended for up to 4 years. A total of 127 555 patients were included, of whom 14.3% were on DPP-4i, 72.5% on sulphonylurea, 13.2% on thiazolidinediones, with average 70.7% being on metformin as combination therapy. Patients in the three groups differed significantly for baseline characteristics: age, sex, Charlson index, concurrent medications, and previous cardiovascular events. During an average 2.6-year follow-up, after adjusting for measured confounders, use of DPP-4i was associated with a reduced risk of HHF compared with sulphonylureas [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.62-0.97; P = 0.026]. After propensity matching, the analysis was restricted to 39 465 patients, and the use of DPP-4i was still associated with a lower risk of HHF (HR 0.70; 95% CI 0.52-0.94; P = 0.018).
  
  
  CONCLUSIONS
  In a very large observational study, the use of DPP-4i was associated with a reduced risk of HHF when compared with sulphonylureas.
authors.affiliation: Department of Medicine, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Fadini
authors.affiliation: Department of Medicine, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy angelo.avogaro@unipd.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Avogaro
authors.affiliation: CliCon S.r.l. Health, Economics and Outcomes Research, 48121 Ravenna, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Degli Esposti
authors.affiliation: Italian Medicines Agency, 00187 Rome, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Russo
authors.affiliation: CliCon S.r.l. Health, Economics and Outcomes Research, 48121 Ravenna, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Saragoni
authors.affiliation: CliCon S.r.l. Health, Economics and Outcomes Research, 48121 Ravenna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Buda
authors.affiliation: Italian Medicines Agency, 00187 Rome, Italy Centro di Ricerca Clinica e Sperimentale, IRCCS San Raffaele Roma IN, Roma, Italy Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, UK.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rosano
authors.affiliation: Italian Medicines Agency, 00187 Rome, Italy University of Brescia, 25121 Brescia, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Pecorelli
authors.affiliation: Italian Medicines Agency, 00187 Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pani
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000188:drug therapy* / Q000453:epidemiology; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000008:administration & dosage*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000008:administration & dosage
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds
keywords: Diabetes; Epidemiology; Heart failure; Incretin; Medications