Effects of antidiabetic drugs on mortality risks in individuals with type 2 diabetes: A prospective cohort study of UK Biobank participants
Araldi et al.,
Effects of antidiabetic drugs on mortality risks in individuals with type 2 diabetes: A prospective cohort..,
medRxiv, doi:10.1101/2023.05.19.23290214 (Preprint)
UK Biobank retrospective including 43,610 type 2 diabetes patients, showing lower mortality with metformin use within matched type 2 diabetes patients.
risk of death, 60.0% lower, HR 0.40, p < 0.001, treatment 107 of 2,598 (4.1%), control 263 of 2,598 (10.1%), NNT 17, adjusted per study, type 2 diabetes patients, matched cohort, multivariable, Cox proportional hazards.
|
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
|
Araldi et al., 19 May 2023, retrospective, United Kingdom, preprint, 3 authors.
Contact:
michael.ristow@charite.de.
Abstract: medRxiv preprint doi: https://doi.org/10.1101/2023.05.19.23290214; this version posted May 19, 2023. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-ND 4.0 International license .
1
Effects of antidiabetic drugs on mortality risks in individuals with type 2 diabetes:
2
A prospective cohort study of UK Biobank participants
3
Elisa Araldi1-2, Catherine R. Jutzeler 3, Michael Ristow 1,4*
4
5
6
7
8
9
10
11
12
13
14
15
1
Energy Metabolism Laboratory, Institute of Translational Medicine, Swiss Federal Institute of
Technology (ETH) Zürich, Schwerzenbach, CH-8603, Switzerland;
2Center for Thrombosis and Hemostasis and Preventive Cardiology and Preventive Medicine,
Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz,
Mainz, D-55131, Germany;
3
Biomedical Data Science Lab, Institute of Translational Medicine, Swiss Federal Institute of
Technology (ETH) Zürich, Zürich, CH-8008, Switzerland;
4Institute of Experimental Endocrinology, Charité Universitätsmedizin Berlin, Humboldt University,
Berlin, D-10117, Germany
16
Abstract
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
Objective: To investigate the mortality risk linked to prescription of different anti-diabetic
medication classes.
Design: Prospective population-based study.
Setting: UK Biobank.
Participants: 410 389 of the 502 536 participants in UK Biobank with covariate data, clinical and
prescription records were included in the analyses, 43 610 of which had been diagnosed type 2
diabetes (T2D). A nearest neighbour covariate matching (NNCM) algorithm based on covariates
with relevant effects on survival was applied to match cohorts of anti-diabetic medication class
users to minimally differing control cohorts, either with a T2D diagnosis or without. Kaplan Meier
estimates and Cox proportional models were used to evaluate survival differences and hazard
ratio between drug classes and controls.
Main outcome measures: All-cause mortality and causes of death.
Results : 13667 (3.3%) individuals died during a median of 12.2 years of follow-up. After applying
NNCM, participants with T2D on metformin (average hazard ratio 0.39, 95% confidence interval
0.31 to 0.49) or SGLT2I (average hazard ratio 0.58, 95% confidence interval 0.36 to 0.93) have
an increased survival probability compared to matched individuals with T2D. When compared to
matched individuals without T2D, the survival probability of individuals with T2D increases only if
prescribed SGLT2I (average hazard ratio 0.31, 95% confidence interval 0.19 to 0.51). NNCMbased analysis of matched individuals with T2D on both SGLT2I and metformin versus metformin
only reveals increased survival in the presence of SGLT2I (average hazard ratio 0.29, 95%
confidence interval 0.09 to 0.91), also when compared to matched identical individuals without
T2D (average hazard ratio 0.05, 95% confidence interval 0.01 to 0.19). All the other anti-diabetic
drugs analyzed are either detrimental in prolonging lifespan (insulin, thiazolidinediones, and
sulfonylureas), or have no effect (DPP4 inhibitors and GLP1 receptor agonists).
Conclusion: The use of the current first-line anti-diabetic treatment, metformin, or sodiumglucose cotransporter 2 inhibitors (SGLT2I) increases the survival probability compared to
matched..
Please send us corrections, updates, or comments. Vaccines and
treatments are complementary. All practical, effective, and safe means should
be used based on risk/benefit analysis. No treatment, vaccine, or intervention
is 100% available and effective for all current and future variants. We do not
provide medical advice. Before taking any medication, consult a qualified
physician who can provide personalized advice and details of risks and
benefits based on your medical history and situation.
FLCCC and
WCH
provide treatment protocols.
Submit