Cardiff University | Prifysgol Caerdydd ORCA
Online Research @ Cardiff 
WelshClear Cookie - decide language by browser settings

Can people with type 2 diabetes live longer than people without diabetes? A comparison of all-cause mortality in people initiated with metformin monotherapy or sulfonylurea monotherapy and matched controls without diabetes

Bannister, Christian, Holden, Sarah E., Jenkins-Jones, Sara, Morgan, Christopher Ll., Halcox, Julian P., Schernthaner, Guntram, Mukherjee, Jayanti and Currie, Craig J. 2014. Can people with type 2 diabetes live longer than people without diabetes? A comparison of all-cause mortality in people initiated with metformin monotherapy or sulfonylurea monotherapy and matched controls without diabetes. Diabetes, Obesity and Metabolism 16 (11) , pp. 1165-1173. 10.1111/dom.12354

Full text not available from this repository.

Abstract

Aims: Clinical and observational studies have demonstrated increased risk of cardiovascular events and death associated with sulfonylureas versus metformin. However, it has never been determined whether this was due to the beneficial effects of metformin or detrimental effects of sulfonylureas. Our objective was therefore to compare all-cause mortality in diabetic patients treated first-line, glucose lowering therapy with either sulfonylurea or metformin monotherapy with that in matched individuals without diabetes. Materials and Methods: We used retrospective observational data from the UK Clinical Practice Research Datalink (CPRD) from 2000. Subjects with type 2 diabetes who progressed to first-line treatment with metformin or sulfonylurea monotherapy were selected and matched to people without diabetes. Progression to all-cause mortality was compared using parametric survival models that included a range of relevant co-variables. Results: We identified 78,241 subjects treated with metformin, 12,222 treated with sulfonylurea, and matched 90,463 cases without diabetes. This resulted in a total, censored follow-up period of 503,384 years. There were 7,498 deaths in total, representing unadjusted mortality rates of 14.4 and 15.2, and 50.9 and 28.7 deaths per 1,000 person-years for metformin monotherapy and their matched controls, and sulfonylurea monotherapy and their matched controls, respectively. With reference to observed survival in diabetic patients initiated with metformin monotherapy, adjusted median survival time was 15% lower (survival time ratio = 0.85, 95%CI 0.81–0.90) than in matched individuals without diabetes, and adjusted median survival time was reduced by 38% (survival time ratio = 0.62, 0.58–0.66) in diabetic patients treated with sulfonylurea monotherapy. Conclusions: Patients with type 2 diabetes initiated with metformin monotherapy had longer survival than did matched, non-diabetic controls. Those treated with sulfonylurea had markedly reduced survival than both matched controls and those receiving metformin monotherapy. This supports the position of metformin as first-line therapy and implies that metformin may confer benefit in non-diabetes. Sulfonylurea remains a continued concern.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Computer Science & Informatics
Medicine
MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Subjects: R Medicine > R Medicine (General)
Publisher: Wiley and Blackwell
ISSN: 1462-8902
Date of Acceptance: 30 June 2014
Last Modified: 21 Feb 2019 14:03
URI: http://orca-mwe.cf.ac.uk/id/eprint/62280

Citation Data

Cited 117 times in Scopus. View in Scopus. Powered By Scopus® Data

Actions (repository staff only)

Edit Item Edit Item