Endocrine Abstracts

Background: Type 2 diabetes (T2DM) is associated with increased risk of cardiovascular (CV) complications. Although evidence suggest SGLT–2 inhibitors and GLP–1 receptor agonists to have a protective effect on CV outcomes they are still not available as a second–line therapy in Lithuania because of costs.

The aim: To examine the risk of hospitalization for CV events associated with diabetes therapies in patients with T2DM.

Methods: Lithuanian National Health Insurance Fund database, covering the period 2012 – 2014 was used to extract all diabetes cases with demographic data, information on complications, concomitant diseases, hospital admissions, prescribed medications. T2DM patients were grouped according to diabetes treatment. Nearest neighbor propensity score matching included age, gender, hypertension, chronic kidney disease, established CVD, diabetes complications, use of statins and ACEI to match the groups. Hospitalization risk for CV complications (miocardial infarction (MI), coronary heart disease (CHD), heart failure (HF), transient ischemic attack (TIA), stroke) was compared between the groups.

Results: From 124416 DM cases extracted, we excluded T1DM, treatment changes or initiation after index period. Matching of remaining 75666 T2DM cases resulted in 7089 patients in each Diet, Metformin, Sulfonylurea (SU)/Insulin and Combination therapy group with similar age – 69 years, women – 62%, established CVD – 58%, hypertension – 87%, use of ACEI – 64% and statins – 7%. About 14% had DM complications, polyneuropathy being diagnosed most commonly in 11% of patients. In SU/Insulin group 53% were on SU, in Combination therapy – 82, 31, 97, 13, 2 and 3% – were respectively on SU, insulin, metformin, DPP–4 inhibitors, thiazolidinediones and GLP–1 receptor agonists. Compared to Metformin risk ratio (RR) for hospitalization was 1.18 [CI 1.11, 1.25] with the highest RR for TIA 1.32 [1.04, 1.67] in Diet, 1.24 [1.17, 1.32] with the highest RR for MI 1.51 [1.36, 1.66] in Su/Insulin, 1.15 [1.09, 1.22] with the highest RR for stroke 1.29 [1.07, 1.55] in Combination therapy groups. Compared to Diet RR for hospitalization was 1.06 [1.00, 1.11] with the highest RR for MI 1.29 [1.07, 1.55] in Su/Insulin. There were no difference between Diet and Combination therapy groups.

Conclusion: More than half of type 2DM subjects have established CVD in Lithuania. Only minority of them are on statins and most are treated with SU or insulin, which significantly increases the risk of hospitalization for CV events. These results strongly support the need of new antidiabetic medications with proved CV benefit for type 2 diabetes treatment.