Key result
Sulphonylurea monotherapy was associated with a higher risk of hospitalization for heart failure compared to acarbose monotherapy in patients with T2DM (aHR 1.61; 95% CI 1.14-2.27).
Why the study?
The risk of heart failure associated with sulphonylureas remains unclear.
Does sulphonylurea monotherapy increase the risk of hospitalization for heart failure compared to acarbose monotherapy in adult patients with type 2 diabetes mellitus?
Cohort (n=15,752)
Does sulphonylurea monotherapy increase the risk of hospitalization for heart failure compared to acarbose monotherapy in adult patients with type 2 diabetes mellitus?
Effect estimate: aHR 1.61 (95% CI 1.14-2.27)
Absolute Event Rate: 22.2% vs 18.3%
In adult patients with type 2 diabetes mellitus, initial treatment with sulphonylurea monotherapy is associated with a 61% higher risk of hospitalization for heart failure compared to acarbose monotherapy.
May support preferring acarbose over sulphonylureas for HF risk in T2DM; hypothesis-generating and requires RCT confirmation.
PURPOSE: The risk of heart failure associated with sulphonylureas is unclear. We evaluated the association between sulphonylureas and hospitalization of heart failure (HHF) in patients with type 2 diabetes mellitus (T2DM) in China. METHODS: A retrospective cohort study was implemented using the Yinzhou Regional Health Care Database (YRHCD). We identified 15 752 adult patients with T2DM who were newly exposed to sulphonylurea monotherapy (N = 12 487) or acarbose monotherapy (N = 3265) from January 2010 to September 2016. Cox proportional hazards models weighted by inverse probability of treatment weights were used to compare the risk of HHF between initiators of sulphonylurea and acarbose. RESULTS: During a median follow-up of 0.55 (0.49, 1.11) and 0.49 (0.35, 0.70) years for sulphonylureas and acarbose initiators separately, 320 patients developed HHF, with 279 events in sulphonylureas group, and 41 events in acarbose group. The incidence rates of HHF among sulphonylureas initiators and acarbose initiators were 22.2 (95% CI 19.6-24.9) and 18.3 (95% CI 13.2-24.9) per 1000 person-years, respectively. The adjusted hazard ratio (aHR) of HHF for sulphonylureas vs acarbose was 1.61 (95% CI 1.14-2.27). When stratified by history of heart failure, aHR was 1.55 (95% CI 0.79-3.06) in patients with a history of heart failure, and 1.64 (95% CI 1.10-2.45) in patients with no history of heart failure. CONCLUSIONS: Our study suggested that use of sulphonylureas monotherapy compared with acarbose monotherapy for initial treatment of T2DM for approximately 0.5 years are significantly associated with a higher risk of HHF.
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Xu et al. (2020) conducted a cohort in type 2 diabetes mellitus (n=15,752). Sulphonylurea monotherapy vs. Acarbose monotherapy was evaluated on Hospitalization of heart failure (HHF) (aHR 1.61, 95% CI 1.14-2.27). Sulphonylurea monotherapy was associated with a higher risk of hospitalization for heart failure compared to acarbose monotherapy in patients with T2DM (aHR 1.61; 95% CI 1.14-2.27).
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