Cardiovascular Drug Use and Hospitalizations Attributable to Type 2 Diabetes
- Joëlle A. Erkens, PHARMD12,
- Olaf H. Klungel, PHARMD, PHD1,
- Ronald P. Stolk, MD, PHD2,
- José A. Spoelstra, MD12,
- Diederick E. Grobbee, MD, PHD2 and
- Hubert G.M. Leufkens, PHARMD, PHD1
- 1Department of Pharmacoepidemiology and Pharmacotherapy and the
- 2Julius Center for Patient Oriented Research, Utrecht University, Utrecht, The Netherlands
Abstract
OBJECTIVE—To investigate cardiovascular drug use and hospitalizations attributable to type 2 diabetes from 1 year before until 6 years after the start of oral antidiabetic therapy.
RESEARCH DESIGN AND METHODS—In this cohort study, 2,584 patients with type 2 diabetes were selected from the PHARMO Record Linkage System, comprising pharmacy records and hospitalizations for all 320,000 residents of six Dutch cities. Patients with type 2 diabetes were identified as incident oral antidiabetic drug users between 1992 and 1997. Nondiabetic subjects were 1:1–matched for age, sex, pharmacy, and index date and received no insulin, oral antidiabetic drugs, or glucose-testing supplies.
RESULTS—Patients with type 2 diabetes were more likely to use cardiovascular drugs (RR 1.28 [95% CI 1.23–1.34]) and to be hospitalized because of cardiovascular diseases (1.54 [1.33–1.78]) after the start of oral antidiabetic therapy than nondiabetic subjects. Differences between patients with type 2 diabetes and nondiabetic subjects lessened from 1 year before until 6 years after the start of oral antidiabetic therapy, reflected by decreasing attributable risks for diuretics, β-blockers, calcium channel blockers, and cardiac and antithrombotic drugs. The difference in use of angiotensin-converting enzyme inhibitors and lipid-lowering drugs increased. Cardiovascular hospitalizations attributable to type 2 diabetes were ∼50% in the years close to the start of oral antidiabetic treatment and decreased to ∼33% in the following years.
CONCLUSIONS—Although cardiovascular drug use and hospitalizations remained increased in patients with type 2 diabetes after the start of oral antidiabetic therapy, cardiovascular drug use attributable to type 2 diabetes decreased after the start of oral antidiabetic therapy, especially β-blockers, whereas cardiovascular hospitalizations first decreased and then stabilized.
Footnotes
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Address correspondence and reprint requests to J.A. Erkens, Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), P.O. Box 80082, 3508 TB Utrecht, The Netherlands. E-mail: j.a.erkens{at}pharm.uu.nl.
Received for publication 5 December 2000 and accepted in revised form 12 April 2001.
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