Inzucchi, S. E.; Tunceli, K.; Qiu, Y.; Rajpathak, S.; Brodovicz, K. G.; Engel, S. S.; Mavros, P.; Radican, L.; Brudi, P.; Li, Z.; Fan, C. P. S.; Hanna, B.; Tang, J.; Blonde, L.
Abstract
Aim: To assess time to insulin initiation among patients with type 2 diabetes mellitus (T2DM) treated with sitagliptin versus sulphonylurea as add-on to metformin.; Methods: This retrospective cohort study used GE Centricity electronic medical records and included patients aged >= 18 years with continuous medical records and an initial prescription of sitagliptin or sulphonylurea (index date) with metformin for >= 90 days during 2006-2013. Sitagliptin and sulphonylurea users were matched 1 : 1 using propensity score matching, and differences in insulin initiation were assessed using Kaplan-Meier curves and Cox regression. We used conditional logistic regression to examine the likelihood of insulin use 1-6 years after the index date for each year.; Results: Propensity score matching produced 3864 matched pairs. Kaplan-Meier analysis showed that sitagliptin users had a lower risk of insulin initiation compared with sulphonylurea users (p=0.003), with 26.6% of sitagliptin users initiating insulin versus 34.1% of sulphonylurea users over 6 years. This finding remained significant after adjusting for baseline characteristics (hazard ratio 0.76, 95% confidence interval 0.65-0.90). Conditional logistic regression analyses confirmed that sitagliptin users were less likely to initiate insulin compared with sulphonylurea users [ odds ratios for years 1-6: 0.77, 0.79, 0.81, 0.57, 0.29 and 0.75, respectively (p<0.05 for years 4 and 5)].; Conclusions: In this real-world matched cohort study, patients with T2DM treated with sitagliptin had a significantly lower risk of insulin initiation compared with patients treated with sulphonylurea, both as add-on to metformin.
