1. Case-control study of second-line therapies for type 2 diabetes in combination with metformin and the comparative risks of myocardial infarction and stroke.
- Author
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Floyd JS, Wiggins KL, Sitlani CM, Flory JH, Dublin S, Smith NL, Heckbert SR, and Psaty BM
- Subjects
- Aged, Case-Control Studies, Diabetes Mellitus, Type 2 complications, Diabetic Angiopathies chemically induced, Diabetic Angiopathies complications, Diabetic Angiopathies epidemiology, Diabetic Angiopathies prevention & control, Diabetic Cardiomyopathies chemically induced, Diabetic Cardiomyopathies complications, Diabetic Cardiomyopathies epidemiology, Diabetic Cardiomyopathies prevention & control, Drug Therapy, Combination adverse effects, Female, Humans, Hypoglycemic Agents adverse effects, Incidence, Insulin adverse effects, Male, Medical Records, Metformin adverse effects, Middle Aged, Myocardial Infarction chemically induced, Myocardial Infarction complications, Myocardial Infarction epidemiology, Practice Guidelines as Topic, Proportional Hazards Models, Risk Factors, Stroke chemically induced, Stroke complications, Stroke epidemiology, Sulfonylurea Compounds adverse effects, Washington epidemiology, Diabetes Mellitus, Type 2 drug therapy, Hypoglycemic Agents therapeutic use, Insulin therapeutic use, Metformin therapeutic use, Myocardial Infarction prevention & control, Stroke prevention & control, Sulfonylurea Compounds therapeutic use
- Abstract
We conducted a population-based case-control study to assess the myocardial infarction (MI) and stroke risks associated with sulphonylureas and insulin when used in combination with metformin. Cases had type 2 diabetes and used metformin + insulin or metformin + sulphonylureas at the time of a first MI or first stroke between 1995 and 2010; controls used the same treatment combinations and were randomly sampled from the same population. MI and stroke diagnoses and potential confounders were validated by medical record reviews. Compared with metformin + sulphonylurea, metformin + insulin was associated with similar risks of MI or stroke [odds ratio 0.98 (95% confidence interval 0.63-1.52)]. Meta-analysis with another observational study improved the precision of the risk estimate [relative risk 0.92 (95% confidence interval 0.69-1.24)]. Current evidence suggests that there may not be large differences in cardiovascular risk associated with the use of insulin or sulphonylureas when used in combination with metformin., (© 2015 John Wiley & Sons Ltd.)
- Published
- 2015
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