Coadministration of DPP-4 inhibitor and insulin therapy does not further reduce the risk of cardiovascular events compared with DPP-4 inhibitor therapy in diabetic foot patients: a nationwide population-based study
Abstract Background The effect of combined insulin and dipeptidyl peptidase-4 inhibitor (DPP4i) therapy on major adverse cardiovascular events (MACEs) in patients with diabetic foot is unclear. Methods We conducted this nationwide cohort study using longitudinal claims data obtained from the Taiwan...
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| Format: | Article |
| Language: | English |
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BMC
2018-10-01
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| Series: | Diabetology & Metabolic Syndrome |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13098-018-0378-6 |
| _version_ | 1819136195473440768 |
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| author | Yi-Hsuan Lin Yu-Yao Huang Yi-Ling Wu Cheng-Wei Lin Pei-Chun Chen Chee Jen Chang Sheng-Hwu Hsieh Jui-Hung Sun Szu-Tah Chen Chia-Hung Lin |
| author_facet | Yi-Hsuan Lin Yu-Yao Huang Yi-Ling Wu Cheng-Wei Lin Pei-Chun Chen Chee Jen Chang Sheng-Hwu Hsieh Jui-Hung Sun Szu-Tah Chen Chia-Hung Lin |
| author_sort | Yi-Hsuan Lin |
| collection | DOAJ |
| description | Abstract Background The effect of combined insulin and dipeptidyl peptidase-4 inhibitor (DPP4i) therapy on major adverse cardiovascular events (MACEs) in patients with diabetic foot is unclear. Methods We conducted this nationwide cohort study using longitudinal claims data obtained from the Taiwan National Health Insurance program and included 19,791 patients with diabetic foot from 2007 to 2014. Patients receiving DPP4i-based therapy and/or insulin-based therapy after a diagnosis of diabetic foot were categorized into combined, DPP4i- or insulin-based groups, respectively. The risk of MACEs including nonfatal myocardial infarction, nonfatal stroke, cardiac death, and heart failure was assessed using Cox proportional hazards analysis and propensity score matching. Results Among the 19,791 patients with diabetic foot (mean age, 58.8 years [SD, 12.5]; men, 51.2%), 6466 received DPP4i-based therapy, 1925 received insulin-based therapy, and 11,400 received combined DPP4i and insulin therapy. The DPP4i-based and insulin-based groups had a lower risk of MACEs (HR 0.53, 95% CI 0.50–0.57 DPP4i only; HR 0.89, 95% CI 0.81–0.97 insulin only) than the combined group. After propensity score matching, the incidence of all complications in the DPP4i-based group was still significantly lower than that in the combined group (HR 0.55, 95% CI 0.51–0.59 for MACEs; HR 0.32, 95% CI 0.24–0.42 for nonfatal myocardial infarction; HR 0.70, 95% CI 0.63–0.78 for nonfatal stroke; HR 0.22, 95% CI 0.13–0.38 for cardiac death; HR 0.22, 95% CI 0.19–0.25 for any death; HR 0.16, 95% CI 0.13–0.20 for amputation). In the diabetic foot patients with end-stage renal disease (ESRD), the benefit of a lower incidence of MACEs in the DPP4i-based group disappeared (HR 0.77, 95% CI 0.58–1.08). Conclusions This study demonstrated that the patients with diabetic foot receiving DPP4i-based therapy had a lower risk of MACEs than those receiving combined therapy with DPP4i and insulin, but that the effect disappeared in those with concurrent ESRD. |
| first_indexed | 2024-12-22T10:31:07Z |
| format | Article |
| id | doaj.art-25dccacc562f4ecb939ebc914120c2df |
| institution | Directory Open Access Journal |
| issn | 1758-5996 |
| language | English |
| last_indexed | 2024-12-22T10:31:07Z |
| publishDate | 2018-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Diabetology & Metabolic Syndrome |
| spelling | doaj.art-25dccacc562f4ecb939ebc914120c2df2022-12-21T18:29:19ZengBMCDiabetology & Metabolic Syndrome1758-59962018-10-0110111110.1186/s13098-018-0378-6Coadministration of DPP-4 inhibitor and insulin therapy does not further reduce the risk of cardiovascular events compared with DPP-4 inhibitor therapy in diabetic foot patients: a nationwide population-based studyYi-Hsuan Lin0Yu-Yao Huang1Yi-Ling Wu2Cheng-Wei Lin3Pei-Chun Chen4Chee Jen Chang5Sheng-Hwu Hsieh6Jui-Hung Sun7Szu-Tah Chen8Chia-Hung Lin9Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial HospitalDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial HospitalResearch Services Center for Health Information, Chang Gung UniversityDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial HospitalDepartment of Public Health, China Medical UniversityResearch Services Center for Health Information, Chang Gung UniversityDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial HospitalDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial HospitalDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial HospitalDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial HospitalAbstract Background The effect of combined insulin and dipeptidyl peptidase-4 inhibitor (DPP4i) therapy on major adverse cardiovascular events (MACEs) in patients with diabetic foot is unclear. Methods We conducted this nationwide cohort study using longitudinal claims data obtained from the Taiwan National Health Insurance program and included 19,791 patients with diabetic foot from 2007 to 2014. Patients receiving DPP4i-based therapy and/or insulin-based therapy after a diagnosis of diabetic foot were categorized into combined, DPP4i- or insulin-based groups, respectively. The risk of MACEs including nonfatal myocardial infarction, nonfatal stroke, cardiac death, and heart failure was assessed using Cox proportional hazards analysis and propensity score matching. Results Among the 19,791 patients with diabetic foot (mean age, 58.8 years [SD, 12.5]; men, 51.2%), 6466 received DPP4i-based therapy, 1925 received insulin-based therapy, and 11,400 received combined DPP4i and insulin therapy. The DPP4i-based and insulin-based groups had a lower risk of MACEs (HR 0.53, 95% CI 0.50–0.57 DPP4i only; HR 0.89, 95% CI 0.81–0.97 insulin only) than the combined group. After propensity score matching, the incidence of all complications in the DPP4i-based group was still significantly lower than that in the combined group (HR 0.55, 95% CI 0.51–0.59 for MACEs; HR 0.32, 95% CI 0.24–0.42 for nonfatal myocardial infarction; HR 0.70, 95% CI 0.63–0.78 for nonfatal stroke; HR 0.22, 95% CI 0.13–0.38 for cardiac death; HR 0.22, 95% CI 0.19–0.25 for any death; HR 0.16, 95% CI 0.13–0.20 for amputation). In the diabetic foot patients with end-stage renal disease (ESRD), the benefit of a lower incidence of MACEs in the DPP4i-based group disappeared (HR 0.77, 95% CI 0.58–1.08). Conclusions This study demonstrated that the patients with diabetic foot receiving DPP4i-based therapy had a lower risk of MACEs than those receiving combined therapy with DPP4i and insulin, but that the effect disappeared in those with concurrent ESRD.http://link.springer.com/article/10.1186/s13098-018-0378-6Diabetic footDipeptidyl peptidase-4 inhibitor-based therapyInsulin therapyCardiovascular complications |
| spellingShingle | Yi-Hsuan Lin Yu-Yao Huang Yi-Ling Wu Cheng-Wei Lin Pei-Chun Chen Chee Jen Chang Sheng-Hwu Hsieh Jui-Hung Sun Szu-Tah Chen Chia-Hung Lin Coadministration of DPP-4 inhibitor and insulin therapy does not further reduce the risk of cardiovascular events compared with DPP-4 inhibitor therapy in diabetic foot patients: a nationwide population-based study Diabetology & Metabolic Syndrome Diabetic foot Dipeptidyl peptidase-4 inhibitor-based therapy Insulin therapy Cardiovascular complications |
| title | Coadministration of DPP-4 inhibitor and insulin therapy does not further reduce the risk of cardiovascular events compared with DPP-4 inhibitor therapy in diabetic foot patients: a nationwide population-based study |
| title_full | Coadministration of DPP-4 inhibitor and insulin therapy does not further reduce the risk of cardiovascular events compared with DPP-4 inhibitor therapy in diabetic foot patients: a nationwide population-based study |
| title_fullStr | Coadministration of DPP-4 inhibitor and insulin therapy does not further reduce the risk of cardiovascular events compared with DPP-4 inhibitor therapy in diabetic foot patients: a nationwide population-based study |
| title_full_unstemmed | Coadministration of DPP-4 inhibitor and insulin therapy does not further reduce the risk of cardiovascular events compared with DPP-4 inhibitor therapy in diabetic foot patients: a nationwide population-based study |
| title_short | Coadministration of DPP-4 inhibitor and insulin therapy does not further reduce the risk of cardiovascular events compared with DPP-4 inhibitor therapy in diabetic foot patients: a nationwide population-based study |
| title_sort | coadministration of dpp 4 inhibitor and insulin therapy does not further reduce the risk of cardiovascular events compared with dpp 4 inhibitor therapy in diabetic foot patients a nationwide population based study |
| topic | Diabetic foot Dipeptidyl peptidase-4 inhibitor-based therapy Insulin therapy Cardiovascular complications |
| url | http://link.springer.com/article/10.1186/s13098-018-0378-6 |
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