title: Comparative Impact of Hypoglycemic Agents on Severity and Extent of Myocardial Ischemia in Patients With Type 2 Diabetes Mellitus Undergoing Myocardial Perfusion Scintigraphy.
abstract: BACKGROUND
  Hypoglycemic agents differ in mechanism, efficacy, and profile. However, there is uncertainty on their impact on myocardial perfusion. We thus aimed to investigate whether individuals with type 2 diabetes mellitus treated with different drug classes exhibit different perfusion patterns at myocardial perfusion scintigraphy (MPS).
  
  
  RESULTS
  We queried our administrative database for patients with diabetes mellitus without prior or recent myocardial infarction. The primary objective was to compare the severity and extent of ischemia at MPS, distinguishing patients according to management strategy. A total of 7592 patients were included [2336 (31%) on diet, 3611 (48%) on metformin, 749 (10%) on sulfonylureas, 449 (6%) on metformin plus sulfonylureas, 447 (6%) on metformin plus insulin]. Unadjusted analyses and analyses adjusting for baseline features suggested that sulfonylureas alone or in combination were associated with more severe ischemia than nonsulfonylurea regimens (P < 0.05), whereas combination regimens including metformin were associated with more extensive myocardial ischemia than the other regimens (P < 0.05 for both). However, no significant difference disfavoring either metformin or sulfonylurea regimens persisted after multivariable adjustment for baseline, stress, and angiographic characteristics (all P > 0.05).
  
  
  CONCLUSIONS
  Several significant differences in baseline, stress, and scintigraphic features appear evident in patients with diabetes mellitus receiving different hypoglycemic agents or regimens.
authors.affiliation: *Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; †Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy; ‡Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy; §Ostia Radiologica, Rome, Italy; ¶Department of Cardiovascular Disease, Ospedale A. Cardarelli, Campobasso, Italy; ‖Department of Cardiovascular Disease, Ospedale F. Veneziale, Isernia, Italy; **Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy; ††Diabetic Foot Unit, Tor Vergata University of Rome, Rome, Italy; and ‡‡Etisan, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Annamaria
authors.initials: A
authors.lastname: Pinto
authors.forename: Francesco
authors.initials: F
authors.lastname: Versaci
authors.forename: Enrica
authors.initials: E
authors.lastname: Procaccini
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Neri
authors.forename: Giorgio
authors.initials: G
authors.lastname: Sesti
authors.forename: Luigi
authors.initials: L
authors.lastname: Uccioli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Vetere
authors.forename: Mariangela
authors.initials: M
authors.lastname: Peruzzi
authors.forename: Francesco
authors.initials: F
authors.lastname: Nudi
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000139:chemically induced / Q000000981:diagnostic imaging*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D008687:Metformin