Association of antidiabetic therapies with lower extremity amputation, mortality and healthcare cost from a nationwide retrospective cohort study in Taiwan
Journal
Scientific reports
Journal Volume
11
Journal Issue
1
Date Issued
2021-03-26
Author(s)
Abstract
We compared risks of clinical outcomes, mortality and healthcare costs among new users of different classes of anti-diabetic medications. This is a population-based, retrospective, new-user design cohort study using the Taiwan National Health Insurance Database between May 2, 2015 and September 30, 2017. An individual was assigned to a medication group based on the first anti-diabetic prescription on or after May 1, 2016: SGLT-2 inhibitors, DPP-4 inhibitors, GLP-1 agonists or older agents (metformin, etc.). Clinical outcomes included lower extremity amputation, peripheral vascular disease, critical limb ischemia, osteomyelitis, and ulcer. We built three Cox proportional hazards models for clinical outcomes and mortality, and three regression models with a log-link function and gamma distribution for healthcare costs, all with propensity-score weighting and covariates. We identified 1,222,436 eligible individuals. After adjustment, new users of SGLT-2 inhibitors were associated with 73% lower mortality compared to those of DPP-4 inhibitors or users of older agents, while 36% lower total costs against those of GLP-1 agonists. However, there was no statistically significant difference in the risk of lower extremity amputation across medication groups. Our study suggested that SGLT-2 inhibitors is associated with lower mortality compared to DPP 4 inhibitors and lower costs compared to GLP-1 agonists.
SDGs
Other Subjects
antidiabetic agent; dipeptidyl peptidase IV inhibitor; GLP1R protein, human; glucagon like peptide 1 receptor; adult; adverse event; aged; amputation; drug therapy; economics; female; health care delivery; human; lower limb; male; middle aged; mortality; peripheral vascular disease; procedures; retrospective study; surgery; Taiwan; young adult; Adult; Aged; Amputation; Delivery of Health Care; Dipeptidyl-Peptidase IV Inhibitors; Female; Glucagon-Like Peptide-1 Receptor; Humans; Hypoglycemic Agents; Lower Extremity; Male; Middle Aged; Peripheral Vascular Diseases; Retrospective Studies; Sodium-Glucose Transporter 2 Inhibitors; Taiwan; Young Adult
Type
journal article