Abstract
867-P: Cardiovascular Outcomes in Patients Initiating a Second Diabetes Medication after Metformin—The BESTMED Study
Diabetes (New York, N.Y.), Vol.73(Supplement_1)
06/14/2024
DOI: 10.2337/db24-867-P
Abstract
Introduction: In patients with T2D at high cardiovascular (CV) risk, several classes of medications have been found to reduce incidence of CV events. However, long-term CV outcomes of T2D medications in lower risk patients are unknown. Methods: We conducted a causal inference study by emulating a target trial using observational data from 12 health systems and insurance plans across the US. Eligible individuals were patients with T2D and hyperglycemia (HbA1c 7.0-11.0% or equivalent glucose levels) at moderate CV risk (no CV disease) on metformin monotherapy who initiated a second T2D medication between 01/01/13 and 09/01/21, with eGFR ≥ 45 ml/min/1.73m2 and with no contraindications to study medications. We compared patients initiating one of the following medication classes: DPP4s, GLP1s, SGLT2s and sulfonylureas (SUs). In each treatment arm we estimated the 5-year risk of a composite outcome (MI, ischemic CVA, HF hospitalization or CV death) after adjustment for demographics, comorbidities and laboratory values at baseline. Results: We studied 55,441 patients followed for a median of 32 (IQR 18-54) months, with a median age of 60 (IQR 52-68) years and median baseline HbA1c of 7.8% (IQR 7.3-8.6%). Of these, 11,195 patients initiated a DPP4, 6,920 a GLP1, 7,911 an SGLT2 and 29,415 an SU; 40,673 (73.4)% of patients stopped the original study drug class before the end of follow-up after a median of 11 (IQR 3-22) months. A total of 2,566 (4.6%) of patients experienced the primary outcome endpoint. The estimated 5-year risk ratios (95% CI), compared to DPP4s, were 0.93 (0.73 - 1.13) for GLP1s, 0.96 (0.83 - 1.14) for SGLT2s and 1.08 (0.98 - 1.19) for SUs. Conclusions: Among patients with T2D at moderate CV risk on metformin monotherapy, incidence of CV events was similar among four classes of most commonly used non-insulin T2D medications. Further research is needed to evaluate the risk of non-CV events to help patients and clinicians to make informed decisions on T2D therapy. Disclosure A. Turchin: Research Support; Eli Lilly and Company, Novo Nordisk. Consultant; Novo Nordisk, Proteomics International. Research Support; AstraZeneca. L. Petito: Research Support; Omron Healthcare Co., Ltd. E. Hegermiller: None. R.M. Carnahan: None. H. Kitzman: Advisory Panel; Novo Nordisk. M. Lansang: Research Support; Abbott, Dexcom, Inc. Consultant; Glooko, Inc. Research Support; Xeris Pharmaceuticals, Inc. M.E. McDonnell: None. V. Nair: None. E.L. Priest: Research Support; Boehringer-Ingelheim, AstraZeneca, Owkin. V. Willey: Other Relationship; Carelon Research. S. Goel: None. A.F. Kaul: None. M. Hernan: Consultant; ProPublica, Cytel. Other Relationship; ADIA Lab, Flatiron, Foundation Medicine. Funding PCORI (DB-2020C2-20308)
Details
- Title: Subtitle
- 867-P: Cardiovascular Outcomes in Patients Initiating a Second Diabetes Medication after Metformin—The BESTMED Study
- Creators
- ALEXANDER TurchinLUCIA PetitoEMMA HegermillerRYAN M. CarnahanHEATHER KitzmanM Cecilia LansangMARIE E. McdonnellVINIT NairELISA L. PriestVINCENT WilleySATYENDER GoelALAN F. KaulMIGUEL Hernan
- Resource Type
- Abstract
- Publication Details
- Diabetes (New York, N.Y.), Vol.73(Supplement_1)
- DOI
- 10.2337/db24-867-P
- ISSN
- 0012-1797
- eISSN
- 1939-327X
- Publisher
- AMER DIABETES ASSOC; ALEXANDRIA
- Grant note
- PCORI: DB-2020C2-20308
PCORI (DB-2020C2-20308)
- Language
- English
- Date published
- 06/14/2024
- Academic Unit
- Epidemiology; Nursing; Injury Prevention Research Center
- Record Identifier
- 9984649055502771
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