title: Effects on Clinical Outcomes of Adding Dipeptidyl Peptidase-4 Inhibitors Versus Sulfonylureas to Metformin Therapy in Patients With Type 2 Diabetes Mellitus.
abstract: BACKGROUND
  Recent studies concluded that dipeptidyl peptidase-4 (DPP-4) inhibitors provide glycemic control but also raised concerns about the risk for heart failure in patients with type 2 diabetes mellitus (T2DM). However, large-scale studies of the effects on cardiovascular outcomes of adding DPP-4 inhibitors versus sulfonylureas to metformin therapy remain scarce.
  
  
  OBJECTIVE
  To compare clinical outcomes of adding DPP-4 inhibitors versus sulfonylureas to metformin therapy in patients with T2DM.
  
  
  METHODS
  Nationwide study using Taiwan's National Health Insurance Research Database.
  
  
  METHODS
  Taiwan.
  
  
  METHODS
  All patients with T2DM aged 20 years or older between 2009 and 2012. A total of 10,089 propensity score-matched pairs of DPP-4 inhibitor users and sulfonylurea users were examined.
  
  
  METHODS
  Cox models with exposure to sulfonylureas and DPP-4 inhibitors included as time-varying covariates were used to compare outcomes. The following outcomes were considered: all-cause mortality, major adverse cardiovascular events (MACEs) (including ischemic stroke and myocardial infarction), hospitalization for heart failure, and hypoglycemia. Patients were followed until death or 31 December 2013.
  
  
  RESULTS
  DPP-4 inhibitors were associated with lower risks for all-cause death (hazard ratio [HR], 0.63 [95% CI, 0.55 to 0.72]), MACEs (HR, 0.68 [CI, 0.55 to 0.83]), ischemic stroke (HR, 0.64 [CI, 0.51 to 0.81]), and hypoglycemia (HR, 0.43 [CI, 0.33 to 0.56]) compared with sulfonylureas as add-on therapy to metformin but had no effect on risks for myocardial infarction and hospitalization for heart failure.
  
  
  CONCLUSIONS
  Observational study design.
  
  
  CONCLUSIONS
  Compared with sulfonylureas, DPP-4 inhibitors were associated with lower risks for all-cause death, MACEs, ischemic stroke, and hypoglycemia when used as add-ons to metformin therapy.
  
  
  BACKGROUND
  None.
authors.forename: Shuo-Ming
authors.initials: SM
authors.lastname: Ou
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Shih
authors.forename: Pei-Wen
authors.initials: PW
authors.lastname: Chao
authors.forename: Hsi
authors.initials: H
authors.lastname: Chu
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Kuo
authors.forename: Yi-Jung
authors.initials: YJ
authors.lastname: Lee
authors.forename: Shuu-Jiun
authors.initials: SJ
authors.lastname: Wang
authors.forename: Chih-Yu
authors.initials: CY
authors.lastname: Yang
authors.forename: Chih-Ching
authors.initials: CC
authors.lastname: Lin
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Der-Cherng
authors.initials: DC
authors.lastname: Tarng
authors.forename: Szu-Yuan
authors.initials: SY
authors.lastname: Li
authors.forename: Yung-Tai
authors.initials: YT
authors.lastname: Chen
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology*; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D057216:Propensity Score; D020521:Stroke / Q000209:etiology; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D008687:Metformin