Endocrinol Metab.  2021 Feb;36(1):70-80. 10.3803/EnM.2020.777.

Effect of Teneligliptin versus Sulfonylurea on Major Adverse Cardiovascular Outcomes in People with Type 2 Diabetes Mellitus: A Real-World Study in Korea

Affiliations
  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
  • 2Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea

Abstract

Background
Results regarding the cardiovascular (CV) effects of dipeptidyl peptidase-4 (DPP-4) inhibitors are inconsistent. This study aimed to assess the effects of teneligliptin, a DPP-4 inhibitor, on the risk of major CV outcomes in type 2 diabetes mellitus (T2DM) patients compared to sulfonylurea.
Methods
From January 1, 2015 to December 31, 2017, we conducted a retrospective cohort study using the Korean National Health Insurance Service database. A total of 6,682 T2DM patients who were newly prescribed DPP-4 inhibitors or sulfonylurea were selected and matched in a 1:1 ratio by propensity score. The hazard ratios (HRs) for all-cause mortality, hospitalization for heart failure (HHF), all-cause mortality or HHF, myocardial infarction (MI), stroke, and hypoglycemia were assessed.
Results
During 641 days of follow-up, the use of teneligliptin was not associated with an increased risk of all-cause mortality (HR, 1.00; 95% confidence interval [CI], 0.85 to 1.19), HHF (HR, 0.99; 95% CI, 0.86 to 1.14), all-cause mortality or HHF (HR, 1.02; 95% CI, 0.90 to 1.14), MI (HR, 0.90; 95% CI, 0.68 to 1.20), and stroke (HR, 1.00; 95% CI, 0.86 to 1.17) compared to the use of sulfonylurea. However, it was associated with a significantly lower risk of hypoglycemia (HR, 0.68; 95% CI, 0.49 to 0.94) compared to sulfonylurea therapy.
Conclusion
Among T2DM patients, teneligliptin therapy was not associated with an increased risk of CV events including HHF, but was associated with a lower risk of hypoglycemia compared to sulfonylurea therapy.

Keyword

Hypoglycemic agents; Cardiovascular diseases; Dipeptidyl-peptidase IV inhibitors; Heart failure; Hypoglycemia

Figure

  • Fig. 1 Comparison of the cumulative incidence for all cardiovascular outcomes and severe hypoglycemia. Comparison of the cumulative incidence for all-cause mortality (A), hospitalization for heart failure (B), hospitalization for heart failure or all-cause mortality (C), myocardial infarction (D), stroke (E), modified 3-point major adverse cardiovascular event outcomes (myocardial infarction, stroke, or all-cause mortality) (F), and severe hypoglycemia (G). HR, hazard ratio; CI, confidence interval.

  • Fig. 2 Cardiovascular outcomes in subgroups of patients with and without established cardiovascular disease at baseline for all outcomes. HR, hazard ratio; CI, confidence interval; ACM, all-cause mortality; CVD, cardiovascular disease; HHF, hospitalization for heart failure; MI, myocardial infarction; 3P-MACE, modified 3-point major adverse cardiovascular events outcomes (myocardial infarction, stroke, or all-cause mortality).

  • Fig. 3 Subgroup analyses for hypoglycemia by age, gender, statin and insulin use, chronic kidney disease, and cardiovascular disease and cancer at baseline. HR, hazard ratio; CI, confidence interval; CKD, chronic kidney disease; CVD, cardiovascular disease.


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