All-cause mortality in patients with diabetes under glucagon-like peptide-1 agonists : a population-based, open cohort study
Toulis, K. A. Hanif, W. Saravanan, P. Willis, B. H. Marshall, T. Kumarendran, B. Gokhale, K. Ghosh, S. Cheng, K. K. Narendran, P.
Toulis, K. A.
Hanif, W.
Saravanan, P.
Willis, B. H.
Marshall, T.
Kumarendran, B.
Gokhale, K.
Ghosh, S.
Cheng, K. K.
Narendran, P.
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Affiliation
University of Birmingham; University Hospitals Birmingham NHS Foundation Trust; University of Warwick; George Eliot Hospital, Nuneaton
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Publication date
2017-03-18
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Research Projects
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Abstract
Aim: The glucagon-like peptide-1 receptor agonist (GLP1a) liraglutide has been described to benefit patients with type 2 diabetes mellitus (T2DM) at high cardiovascular risk. However, there are still uncertainties relating to these cardiovascular benefits: whether they also apply to an unselected diabetic population that includes low-risk patients, represent a class-effect, and could be observed in a real-world setting.
Methods: We conducted a population-based, retrospective open cohort study using data derived from The Health Improvement Network database between Jan 2008 to Sept 2015. Patients with T2DM exposed to GLP1a (n=8345) were compared to age, gender, body mass index, duration of T2DM and smoking status-matched patients with T2DM unexposed to GLP1a (n=16,541).
Results: Patients with diabetes receiving GLP1a were significantly less likely to die from any cause compared to matched control patients with diabetes (adjusted incidence rate ratio [aIRR]: 0.64, 95% CI: 0.56-0.74, P-value<0.0001). Similar findings were observed in low-risk patients (aIRR: 0.64, 95% CI: 0.53-0.76, P -value=0.0001). No significant difference in the risk of incident CVD was detected in the low-risk patients (aIRR: 0.93, 95% CI: 0.83-1.12). Subgroup analyses suggested that effect is persistent in the elderly or across glycated haemoglobin categories.
Conclusions: GLP1a treatment in a real-world setting may confer additional mortality benefit in patients with T2DM irrespective of their baseline CVD risk, age or baseline glycated haemoglobin and was sustained over the observation period.
Citation
Toulis KA, Hanif W, Saravanan P, Willis BH, Marshall T, Kumarendran B, Gokhale K, Ghosh S, Cheng KK, Narendran P, Thomas GN, Nirantharakumar K. All-cause mortality in patients with diabetes under glucagon-like peptide-1 agonists: A population-based, open cohort study. Diabetes Metab. 2017 Jun;43(3):211-216. doi: 10.1016/j.diabet.2017.02.003. Epub 2017 Mar 18.
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Article