The Effect of DPP4 Inhibitors, Thiazolidinediones, and Sulfonylureas on Rotator Cuff Disease in Patients with Diabetes Mellitus: A Nationwide Retrospective Cohort Study

Background and Objectives: This study compared the risks of rotator cuff disease and rotator cuff repair surgery in patients receiving dipeptidyl peptidase 4 inhibitors (DPP4is), thiazolidinediones (TZDs), and sulfonylureas (SUs). Materials and Methods: A retrospective cohort analysis of Taiwan’s National Health Insurance Research Database was conducted to identify patients with type 2 diabetes mellitus who were newly prescribed DPP4is, TZDs, or SUs between 2012 and 2020. The outcomes of interest were rotator cuff disease and rotator cuff repair surgery. Cox proportional hazard regression models were used to calculate HRs with 95% CIs for the outcomes. Results: Initially, 334,322 DPP4is users, 87,738 TZDs users, and 928,479 SUs users were included. After propensity scores with inverse probability of treatment weighting were calculated with 5% trimming, Sus users had a significantly lower risk of rotator cuff disease than DPP4is users (HR 0.914, 95% CI: 0.898–0.930) and TZDs users (HR 0.887, 95% CI: 0.871–0.904) did, and DPP4is users had a significantly lower risk of this disease than TZDs users had (0.956, 95% CI: 0.926–0.986). As for the risk of rotator cuff repair surgery, the effect sizes did not reach statistical significance. Conclusions: SUs users had the lowest risk of rotator cuff disease, followed by DPP4is and TZDs users.