Key result
Vildagliptin was associated with a significantly lower incidence of retinopathy (OR 0.55) and neuropathy (OR 0.71) compared to sulfonylurea in patients with type 2 diabetes.
Why the study?
Does vildagliptin reduce microvascular complications compared to sulfonylurea in patients with type 2 diabetes?
Cohort (n=6,030)
Yes
Does vildagliptin reduce microvascular complications compared to sulfonylurea in patients with type 2 diabetes?
In a real-world German cohort, vildagliptin was associated with a lower risk of microvascular complications, particularly neuropathy and retinopathy, compared to sulfonylureas in patients with type 2 diabetes.
Answers are grounded in this paper and cite their sources.
Vildagliptin may be associated with fewer microvascular events than SU; hypothesis-generating and requires randomized confirmation.
INTRODUCTION: Preliminary data suggest that dipeptidyl peptidase-4 (DPP-4) inhibitors may reduce microvascular events, but there is a little evidence to support this from adequate real-world studies. This study aimed to compare microvascular outcomes between patients-prescribed vildagliptin and those prescribed sulfonylurea (SU). METHODS: This retrospective cohort study was conducted on a large sample from the German electronic medical records database IMS Lifelink Disease Analyzer. We used propensity score-matched samples of patients prescribed either vildagliptin or SU. Exposure was defined as therapy (SU or vildagliptin); primary outcomes were a diagnosis of retinopathy, nephropathy, neuropathy, or diabetic foot ulcer over the observation period in patients with no previous record of these outcomes. Secondary outcome was a composite of any primary outcome occurring in the observation period. RESULTS: In total, 16,321 patients prescribed SU and 4481 prescribed vildagliptin met the inclusion criteria. After propensity score matching, each sample comprised 3015 patients. Mean age was 63.7/64.6 years for SU/vildagliptin, respectively, with mean disease duration of 3.2/3.1 years, and mean treatment duration of 2.5/2.3 years. Treatment with vildagliptin was associated with a significant lower incidence of retinopathy [odds ratio (OR) = 0.55, P = 0.0004], neuropathy (OR 0.71, P = 0.0001), and composite outcome (OR 0.70, P < 0.0001). Incidences of nephropathy and diabetic foot ulcer were lower for vildagliptin, but not significantly so (OR 0.90, P = 0.3920; OR 0.76, P = 0.0742, respectively). There were no significant differences in incident rate ratios (all P > 0.05). CONCLUSION: Treatment with vildagliptin was associated with a reduced incidence of microvascular complications, especially neuropathy and retinopathy, compared to treatment with SU in this clinical practice setting.
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Kolaczyński et al. (2016) conducted a cohort in Type 2 Diabetes Mellitus (n=6,030). Vildagliptin vs. Sulfonylurea was evaluated on First recorded occurrence of diabetic retinopathy (OR 0.55, 95% CI 0.39-0.77, p=0.0004). Vildagliptin was associated with a significantly lower incidence of retinopathy (OR 0.55) and neuropathy (OR 0.71) compared to sulfonylurea in patients with type 2 diabetes.
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