The association of the treatment with glucagon-like peptide-1 receptor agonist exenatide or insulin with cardiovascular outcomes in patients with type 2 diabetes: a retrospective observational study

Abstract

BackgroundTo evaluate the association of treatment with glucagon-like peptide-1 (GLP-1) receptor agonist exenatide and/or insulin on macrovascular outcomes in patients with type 2 diabetes (T2DM).MethodsWe conducted a retrospective longitudinal pharmaco-epidemiological study using large ambulatory care data to evaluate the risks of heart failure (HF), myocardial infarction (MI) and stroke in established T2DM patients who received a first prescription of exenatide twice daily (EBID) or insulin between June 2005 and May 2009, with follow-up data available until December 2012. Three treatment groups were: EBID with oral antidiabetes drugs (OADs) (EBID, n = 2804), insulin with OADs (Insulin, n = 28551), and those who changed medications between EBID and insulin or had combination of EBID and insulin during follow-up, along with OADs (EBID + insulin, n = 7870).Multivariate Cox-regression models were used to evaluate the association of treatment groups with the risks of macrovascular events.ResultsDuring a median 3.5 years of follow-up, cardiovascular event rates per 1000 person-years were significantly lower for the EBID and EBID + insulin groups compared to the insulin group (HF: 4.4 and 6.1 vs. 17.9; MI: 1.1 and 1.2 vs. 2.5; stroke: 2.4 and 1.8 vs. 6.1). Patients in the EBID/EBID + insulin group had significantly reduced risk of HF, MI and stroke by 61/56%, 50/38% and 52/63% respectively, compared to patients in the insulin group (p < 0.01).ConclusionsTreatment with exenatide, with or without concomitant insulin was associated with reduced macrovascular risks compared to insulin; although inherent potential bias in epidemiological studies should be considered.

Healthcare resource utilization and related financial costs associated with glucose lowering with either exenatide or basal insulin: A retrospective cohort study

“…Furthermore, in randomized trials, EQW has been reported to provide improved glycaemic control compared with EBID . In a retrospective study, exenatide was associated with a reduced cardiovascular risk compared with insulin …”

Data Mining Approach to Estimate the Duration of Drug Therapy from Longitudinal Electronic Medical Records

“…Furthermore, treatment duration estimates from the "continuous" approach are more sensible to the set of selected medications. The difference between methods is particularly prominent in studies involving multiple drugs as opposed to single drug therapies or focusing on the order of treatment initiation [48,49].…”

“…Such real-world analysis provides an extremely valuable means for the understanding of drug utilization patterns, treatment initiation periods following the diagnosis of a disease, the effectiveness of specific therapies on disease-related risk factors, and possible associations of therapies with long-term outcomes [1,6]. These studies warrant appropriate extraction of longitudinal information on prescriptions or medications at individual patient level, inappropriate extraction of the data may result in misleading inferences reported [33 -35].…”

Mechanisms for the cardiovascular effects of glucagon-like peptide-1

“…Further, in diabetic patients, GLP‐1 agonists and DPP4 inhibitors both reduce the risk of heart failure, stroke and MI (Paul et al . , Velez et al . ).…”