Impact of oral anti-hyperglycemic therapy on all-cause mortality among patients with diabetes in the Veterans Health Administration

Abstract

Objective: The objective of this analysis was to evaluate the impact of several classes of oral anti-hyperglycemic therapy relative to sulfonylurea monotherapy on all-cause mortality among a cohort of patients with diabetes from the Veterans Health Administration (VHA).

Research Design and Methods: A retrospective cohort study using data obtained from the VHA Diabetes Epidemiology Cohort was employed. Users of oral anti-hyperglycemic therapy were classified into the following cohorts: sulfonylurea monotherapy, metformin monotherapy, metformin + sulfonylurea, TZD use alone or in combination with other oral agents (TZD users), and no drug therapy. All-cause mortality was the outcome of interest. Multivariate mixed models incorporating a propensity score to account for imbalance among cohorts were used to estimate drug effects on mortality with associated 95% confidence intervals (95%CI).

Results: 39,721 patients with diabetes were included in the study. Adjusted odds ratios and 95%CIs for all-cause mortality were 0.87 (0.68, 1.10) for metformin monotherapy users, 0.92 (0.82, 1.05) for metformin + sulfonylurea users, 1.04 (0.75, 1.46) for TZD users, relative to sulfonylurea monotherapy users.

Conclusions: We did not find any significant drug effect on all-cause mortality for any oral treatment cohorts relative to sulfonylurea oral-monotherapy.