Back to Search
Start Over
Coadministration of DPP-4 inhibitor and insulin therapy does not further reduce the risk of cardiovascular events compared with DPP-4 inhibitor therapy in diabetic foot patients: a nationwide population-based study
- Source :
- Diabetology & Metabolic Syndrome, Diabetology & Metabolic Syndrome, Vol 10, Iss 1, Pp 1-11 (2018)
- Publication Year :
- 2018
- Publisher :
- BioMed Central, 2018.
-
Abstract
- Background The effect of combined insulin and dipeptidyl peptidase-4 inhibitor (DPP4i) therapy on major adverse cardiovascular events (MACEs) in patients with diabetic foot is unclear. Methods We conducted this nationwide cohort study using longitudinal claims data obtained from the Taiwan National Health Insurance program and included 19,791 patients with diabetic foot from 2007 to 2014. Patients receiving DPP4i-based therapy and/or insulin-based therapy after a diagnosis of diabetic foot were categorized into combined, DPP4i- or insulin-based groups, respectively. The risk of MACEs including nonfatal myocardial infarction, nonfatal stroke, cardiac death, and heart failure was assessed using Cox proportional hazards analysis and propensity score matching. Results Among the 19,791 patients with diabetic foot (mean age, 58.8 years [SD, 12.5]; men, 51.2%), 6466 received DPP4i-based therapy, 1925 received insulin-based therapy, and 11,400 received combined DPP4i and insulin therapy. The DPP4i-based and insulin-based groups had a lower risk of MACEs (HR 0.53, 95% CI 0.50–0.57 DPP4i only; HR 0.89, 95% CI 0.81–0.97 insulin only) than the combined group. After propensity score matching, the incidence of all complications in the DPP4i-based group was still significantly lower than that in the combined group (HR 0.55, 95% CI 0.51–0.59 for MACEs; HR 0.32, 95% CI 0.24–0.42 for nonfatal myocardial infarction; HR 0.70, 95% CI 0.63–0.78 for nonfatal stroke; HR 0.22, 95% CI 0.13–0.38 for cardiac death; HR 0.22, 95% CI 0.19–0.25 for any death; HR 0.16, 95% CI 0.13–0.20 for amputation). In the diabetic foot patients with end-stage renal disease (ESRD), the benefit of a lower incidence of MACEs in the DPP4i-based group disappeared (HR 0.77, 95% CI 0.58–1.08). Conclusions This study demonstrated that the patients with diabetic foot receiving DPP4i-based therapy had a lower risk of MACEs than those receiving combined therapy with DPP4i and insulin, but that the effect disappeared in those with concurrent ESRD. Electronic supplementary material The online version of this article (10.1186/s13098-018-0378-6) contains supplementary material, which is available to authorized users.
- Subjects :
- medicine.medical_specialty
Endocrinology, Diabetes and Metabolism
medicine.medical_treatment
030209 endocrinology & metabolism
030204 cardiovascular system & hematology
Lower risk
Dipeptidyl peptidase-4 inhibitor-based therapy
03 medical and health sciences
0302 clinical medicine
Diabetes mellitus
Internal medicine
Internal Medicine
medicine
Cardiovascular complications
Myocardial infarction
lcsh:RC620-627
business.industry
Insulin
Research
medicine.disease
Diabetic foot
lcsh:Nutritional diseases. Deficiency diseases
Heart failure
Propensity score matching
Insulin therapy
business
Cohort study
Subjects
Details
- Language :
- English
- ISSN :
- 17585996
- Volume :
- 10
- Database :
- OpenAIRE
- Journal :
- Diabetology & Metabolic Syndrome
- Accession number :
- edsair.doi.dedup.....f598aa0d66a56e8b3579c87899de71d1