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Incretin-based therapy and the risk of diabetic foot ulcers and related events.
Werkman, Nikki C C; Driessen, Johanna H M; Klungel, Olaf H; Schaper, Nicolaas S; Souverein, Patrick C; Stehouwer, Coen D A; Nielen, Johannes T H.
Afiliação
  • Werkman NCC; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, The Netherlands.
  • Driessen JHM; Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands.
  • Klungel OH; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
  • Schaper NS; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, The Netherlands.
  • Souverein PC; Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands.
  • Stehouwer CDA; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
  • Nielen JTH; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, The Netherlands.
Diabetes Obes Metab ; 26(9): 3764-3780, 2024 Sep.
Article em En | MEDLINE | ID: mdl-38951877
ABSTRACT

AIM:

To investigate the effect of dipeptidyl peptidase-4 inhibitors (DPP4-Is) and glucagon-like peptide-1 receptor agonists (GLP1-RAs) on diabetic foot ulcer (DFU) and DFU-related outcomes (lower limb amputation [LLA], DFU-related hospitalization and mortality).

METHODS:

We performed a cohort study with data from the Clinical Practice Research Datalink Aurum database with linkage to hospital data. We included people with type 2 diabetes starting treatment with metformin. Then we propensity score matched new users of DPP4-Is and sulphonylureas (N = 98 770), and new users of GLP1-RAs and insulin (N = 25 422). Cox proportional hazards models estimated the hazard ratios (HRs) for the outcomes.

RESULTS:

We observed a lower risk of DFU with both DPP4-I use versus sulphonylurea use (HR 0.88, 95% confidence interval [CI] 0.79-0.97) and GLP1-RA use versus insulin use (HR 0.44, 95% CI 0.32-0.60) for short-term exposure (≤ 400 days) and HR 0.74 (95% CI 0.60-0.92) for long-term exposure (>400 days). Furthermore, the risks of hospitalization and mortality were lower with both DPP4-I use and GLP1-RA use. The risk of LLA was lower with GLP1-RA use. The results remained consistent across several sensitivity analyses.

CONCLUSIONS:

Incretin-based therapy was associated with a lower risk of DFU and DFU-related outcomes. This suggests benefits for the use of this treatment in people at risk of DFU.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pé Diabético / Diabetes Mellitus Tipo 2 / Inibidores da Dipeptidil Peptidase IV / Incretinas / Receptor do Peptídeo Semelhante ao Glucagon 1 / Amputação Cirúrgica / Hipoglicemiantes Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Diabetes Obes Metab Assunto da revista: ENDOCRINOLOGIA / METABOLISMO Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Holanda

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pé Diabético / Diabetes Mellitus Tipo 2 / Inibidores da Dipeptidil Peptidase IV / Incretinas / Receptor do Peptídeo Semelhante ao Glucagon 1 / Amputação Cirúrgica / Hipoglicemiantes Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Diabetes Obes Metab Assunto da revista: ENDOCRINOLOGIA / METABOLISMO Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Holanda