Do second-line oral antidiabetic drugs have different long-term effects on persons with young-onset type 2 diabetes? ---A nationwide population base cohort study

Abstract

Background: People with young-onset diabetes (YOD) exhibit a higher risk of morbidity and mortality than those with late-onset diabetes. Few studies have explored the preferred management of diabetes in such patients; therefore, we compared the risks of hospitalization and mortality among people with YOD to whom second-line oral antidiabetic drugs (OADs) were administered.Methods: We conducted a nationwide cohort study using the National Health Insurance Research Database (Taiwan). A total of 7257 people taking second-line OADs after initial metformin therapy were enrolled during 2009–2014. Using add-on sulfonylureas (SUs) as a reference, the multivariable Cox regression model was used to compare the risks of hospitalization and mortality among 5 categories of second-line OADs: alpha-glucosidase inhibitors, meglitinide, dipeptidyl peptidase-4 (DPP-4) inhibitors, SUs, and thiazolidinediones.Results: The mean age of patients, duration of diabetes, and follow-up period were 31.6, 3.3, and 1.9 years, respectively. After baseline characteristics, comorbidities, duration of diabetes, and cardiovascular drug use were controlled, the adjusted hazard ratios and 95% confidence interval for all-cause, cardiovascular, and non-infection hospitalization and all-cause mortality for metformin plus DPP-4 inhibitors were 0.62 (0.52–0.73), 0.49 (0.29–0.85), 0.64 (0.54–0.76), and 0.50 (0.27–0.92), respectively, when compared with the data for metformin plus SUs.Conclusions: We found that among people with YOD, taking add-on DPP-4 inhibitors was associated with lower risks of all-cause hospitalization and mortality than taking add-on SUs. DPP-4 inhibitors thus seem to be a suitable second-line OAD for such patients.Trial registration: retrospectively registered