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Association of heart failure severity with risk of diabetes: a Danish nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature260831
Source
Diabetologia. 2014 Aug;57(8):1595-600
Publication Type
Article
Date
Aug-2014
Author
Malene N Demant
Gunnar H Gislason
Lars Køber
Allan Vaag
Christian Torp-Pedersen
Charlotte Andersson
Source
Diabetologia. 2014 Aug;57(8):1595-600
Date
Aug-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cohort Studies
Denmark
Diabetes Mellitus, Type 2 - epidemiology - etiology
Female
Heart Failure - complications - diagnosis - epidemiology
Humans
Incidence
Male
Middle Aged
Prognosis
Registries
Risk
Severity of Illness Index
Abstract
Heart failure has been suggested to increase the risk of developing diabetes. We investigated the relation between heart failure severity, defined by loop-diuretic dosage, and the risk of developing diabetes in a nationwide cohort of patients with heart failure.
We followed all Danish patients discharged from hospitalisation for first-time heart failure in 1997-2010, without prior use of hypoglycaemic agents, until a claimed prescription for hypoglycaemic agents, death or 31 December 2010. The association of loop-diuretic dosage (furosemide equivalents) 90 days after discharge (study baseline) with risk of diabetes was estimated by multivariate Cox regression models.
In total, 99,362 patients were included and divided into five loop-diuretic dose groups: 30,838 (31%) used no loop diuretics; 24,389 (25%) used >0-40 mg/day; 17,355 (17%) used >40-80 mg/day; 11,973 (12%) used >80-159 mg/day; and 14,807 (15%) used =160 mg/day. A total of 7,958 patients (8%) developed diabetes. Loop-diuretic dosages were associated with an increased risk of developing diabetes in a dose-dependent manner. Concomitant use of renin-angiotensin system inhibitors (RASis) attenuated the risk (p value for interaction
Notes
Comment In: Nat Rev Endocrinol. 2014 Aug;10(8):453-424981458
Comment In: Diabetologia. 2014 Sep;57(9):200025005335
PubMed ID
24849568 View in PubMed
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Heart failure severity, as determined by loop diuretic dosages, predicts the risk of developing diabetes after myocardial infarction: a nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature140542
Source
Eur J Heart Fail. 2010 Dec;12(12):1333-8
Publication Type
Article
Date
Dec-2010
Author
Charlotte Andersson
Mette L Norgaard
Peter R Hansen
Emil L Fosbøl
Michelle Schmiegelow
Peter Weeke
Jonas B Olesen
Jakob Raunsø
Casper H Jørgensen
Allan Vaag
Lars Køber
Christian Torp-Pedersen
Gunnar H Gislason
Author Affiliation
Department of Cardiology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, DK 2900 Hellerup, Denmark. ca@heart.dk
Source
Eur J Heart Fail. 2010 Dec;12(12):1333-8
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Aged
Cohort Studies
Confidence Intervals
Denmark - epidemiology
Diabetes Mellitus - epidemiology - etiology
Female
Health Status Indicators
Heart Failure - complications - drug therapy - mortality - pathology
Humans
Incidence
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Infarction - complications
Prevalence
Prognosis
Proportional Hazards Models
Renin-Angiotensin System - drug effects
Risk
Risk assessment
Severity of Illness Index
Sodium Potassium Chloride Symporter Inhibitors - therapeutic use
Abstract
Heart failure (HF) is associated with increased insulin resistance, but the consequences of HF for development of diabetes are not well studied. The aim of the present study was to investigate the relationship between HF severity and risk of developing diabetes in a nationwide cohort of patients with myocardial infarction (MI).
Patients discharged from first-time MI during 1997-2006 and not previously treated with glucose-lowering medications (GLM) or loop diuretics were identified from Danish nationwide registers. Heart failure severity was determined by loop diuretic dosage after discharge. Patients were followed until first claimed prescription of GLM, death, or until the end of 2006. The cohort comprised 50 874 patients. A total of 3006 (6%) had mild (loop-diuretic dosage=40 mg/day), 5383 (11%) moderate (>40-120 mg/day), and 1127 (2%) severe (>120 mg/day) HF. During follow-up, 2531 (5%) patients developed diabetes. Increasing HF severity was associated with increased risk of diabetes, but the use of renin-angiotensin system inhibitors (RASi) attenuated the risk (P-value for interaction between the HF group and RASi
PubMed ID
20864482 View in PubMed
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Metformin in combination with various insulin secretagogues in type 2 diabetes and associated risk of cardiovascular morbidity and mortality--a retrospective nationwide study.

https://arctichealth.org/en/permalink/ahliterature265783
Source
Diabetes Res Clin Pract. 2015 Jan;107(1):104-12
Publication Type
Article
Date
Jan-2015
Author
Ulrik Madvig Mogensen
Charlotte Andersson
Emil Loldrup Fosbøl
Tina Ken Schramm
Allan Vaag
Nikolai Madrid Scheller
Christian Torp-Pedersen
Gunnar Gislason
Lars Køber
Source
Diabetes Res Clin Pract. 2015 Jan;107(1):104-12
Date
Jan-2015
Language
English
Publication Type
Article
Keywords
Aged
Carbamates - administration & dosage
Cardiovascular Diseases - epidemiology - mortality
Denmark - epidemiology
Diabetes Mellitus, Type 2 - blood - drug therapy - epidemiology
Drug Therapy, Combination
Female
Gliclazide - administration & dosage
Glipizide - administration & dosage
Glyburide - administration & dosage
Humans
Hypoglycemic Agents - administration & dosage
Male
Metformin - administration & dosage
Middle Aged
Morbidity
Myocardial Infarction - mortality
Piperidines - administration & dosage
Registries - statistics & numerical data
Retrospective Studies
Risk factors
Stroke - mortality
Sulfonylurea Compounds - administration & dosage
Tolbutamide - administration & dosage
Abstract
Metformin is the first-line treatment for most patients with type 2 diabetes but many patients need additional treatment with insulin secretagogues (IS) to achieve glycemic control. We aimed to compare mortality and cardiovascular risk among users of metformin in combination with pharmacologically different ISs.
Using nationwide administrative Danish registries, we followed all individuals without prior stroke or myocardial infarction who initiated metformin and an IS from 1997 through 2009. Rate ratios (RR) of all-cause mortality, cardiovascular death, and a composite of myocardial infarction, stroke, or cardiovascular death were compared between user groups using time-dependent multivariable Poisson regression models. The most common combination, glimepiride+metformin, was used as reference.
A total of 56,827 patients were included, 56% male, the mean age was 61 ± 12.5 years, and median duration of prior monotherapy was 2.2 (inter quartile range 0.5-4.5) years. Crude incidence rates of mortality for combinations of ISs with metformin were; 15.4 (repaglinide), 28.1 (glipizide), 23.7 (glibenclamide), 21.1 (gliclazide), 20.7 (glimepiride), 27.7 (tolbutamide) deaths per 1000 person years. In adjusted analysis, the associated mortality risk was similar for users of gliclazide+metformin (RR=1.01 [0.88-1.15]), repaglinide+metformin (RR=0.81 [0.62-1.05]), glibenclamide+metformin (RR=0.98 [0.87-1.10]), and tolbutamide+metformin (RR=1.04 [0.85-1.28]). Users of glipizide+metformin was associated with increased all-cause mortality (RR=1.16 [1.02-1.32], p=0.02), cardiovascular death (RR=1.21 [1.01-1.46], p=0.04), and the combined endpoint (RR=1.20 [1.06-1.36, p=0.005).
Most ISs in combination with metformin were associated with similar mortality and cardiovascular risk. Whether glipizide is associated with increased risk compared with other ISs when used in combinations with metformin warrants further study.
PubMed ID
25458330 View in PubMed
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Mortality and cardiovascular risk associated with different insulin secretagogues compared with metformin in type 2 diabetes, with or without a previous myocardial infarction: a nationwide study.

https://arctichealth.org/en/permalink/ahliterature135502
Source
Eur Heart J. 2011 Aug;32(15):1900-8
Publication Type
Article
Date
Aug-2011
Author
Tina Ken Schramm
Gunnar Hilmar Gislason
Allan Vaag
Jeppe Nørgaard Rasmussen
Fredrik Folke
Morten Lock Hansen
Emil Loldrup Fosbøl
Lars Køber
Mette Lykke Norgaard
Mette Madsen
Peter Riis Hansen
Christian Torp-Pedersen
Author Affiliation
Department of Cardiology B, section 2141, Rigshospitalet, The Heart Center, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. tks@heart.dk
Source
Eur Heart J. 2011 Aug;32(15):1900-8
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cause of Death
Denmark - epidemiology
Diabetes Mellitus, Type 2 - drug therapy - mortality
Diabetic Angiopathies - mortality
Humans
Hypoglycemic agents - therapeutic use
Insulin - analogs & derivatives
Kaplan-Meier Estimate
Metformin - therapeutic use
Middle Aged
Myocardial Infarction - mortality
Risk factors
Stroke - mortality
Treatment Outcome
Young Adult
Abstract
The impact of insulin secretagogues (ISs) on long-term major clinical outcomes in type 2 diabetes remains unclear. We examined mortality and cardiovascular risk associated with all available ISs compared with metformin in a nationwide study.
All Danish residents >20 years, initiating single-agent ISs or metformin between 1997 and 2006 were followed for up to 9 years (median 3.3 years) by individual-level linkage of nationwide registers. All-cause mortality, cardiovascular mortality, and the composite of myocardial infarction (MI), stroke, and cardiovascular mortality associated with individual ISs were investigated in patients with or without previous MI by multivariable Cox proportional-hazard analyses including propensity analyses. A total of 107 806 subjects were included, of whom 9607 had previous MI. Compared with metformin, glimepiride (hazard ratios and 95% confidence intervals): 1.32 (1.24-1.40), glibenclamide: 1.19 (1.11-1.28), glipizide: 1.27 (1.17-1.38), and tolbutamide: 1.28 (1.17-1.39) were associated with increased all-cause mortality in patients without previous MI. The corresponding results for patients with previous MI were as follows: glimepiride: 1.30 (1.11-1.44), glibenclamide: 1.47 (1.22-1.76), glipizide: 1.53 (1.23-1.89), and tolbutamide: 1.47 (1.17-1.84). Results for gliclazide [1.05 (0.94-1.16) and 0.90 (0.68-1.20)] and repaglinide and [0.97 (0.81-1.15) and 1.29 (0.86-1.94)] were not statistically different from metformin in both patients without and with previous MI, respectively. Results were similar for cardiovascular mortality and for the composite endpoint.
Monotherapy with the most used ISs, including glimepiride, glibenclamide, glipizide, and tolbutamide, seems to be associated with increased mortality and cardiovascular risk compared with metformin. Gliclazide and repaglinide appear to be associated with a lower risk than other ISs.
Notes
Comment In: Ann Intern Med. 2012 Jan 17;156(2):JC1-722250169
Comment In: Eur Heart J. 2011 Aug;32(15):1832-421471136
Erratum In: Eur Heart J. 2012 May;33(10):1183
PubMed ID
21471135 View in PubMed
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Sulfonylurea in combination with insulin is associated with increased mortality compared with a combination of insulin and metformin in a retrospective Danish nationwide study.

https://arctichealth.org/en/permalink/ahliterature271849
Source
Diabetologia. 2015 Jan;58(1):50-8
Publication Type
Article
Date
Jan-2015
Author
Ulrik M Mogensen
Charlotte Andersson
Emil L Fosbøl
Tina K Schramm
Allan Vaag
Nikolai M Scheller
Christian Torp-Pedersen
Gunnar Gislason
Lars Køber
Source
Diabetologia. 2015 Jan;58(1):50-8
Date
Jan-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Denmark - epidemiology
Diabetes Mellitus, Type 2 - complications - drug therapy - mortality
Diabetic Angiopathies - mortality
Drug Therapy, Combination
Female
Humans
Hypoglycemic Agents - administration & dosage
Insulin - administration & dosage
Male
Metformin - administration & dosage
Middle Aged
Myocardial Infarction - complications - mortality
Registries
Retrospective Studies
Sulfonylurea Compounds - administration & dosage
Abstract
Individual sulfonylureas (SUs) and metformin have, in some studies, been associated with unequal hypoglycaemic, cardiovascular and mortality risks when used as monotherapy in type 2 diabetes. We investigated the outcomes in patients treated with different combinations of SUs and insulin vs a combination of metformin and insulin in a retrospective nationwide study.
All Danish individuals using dual therapy with SU?+?insulin or metformin?+?insulin without prior myocardial infarction (MI) or stroke were followed from 1 January 1997 to 31 December 2009 in nationwide registries. Risks of all-cause mortality, cardiovascular death, hypoglycaemia and a composite endpoint of MI, stroke and cardiovascular death were compared. Rate ratios (RR) [95% CIs] were calculated using time-dependent multivariable Poisson regression analysis.
A total of 11,081 patients used SU?+?insulin and 16,910 used metformin?+?insulin. Patients receiving metformin?+?insulin were younger and had less comorbidity and a longer history of glucose-lowering treatment. SU?+?insulin was associated with higher mortality rates compared with metformin?+?insulin (76-126 vs 23 per 1,000 person-years). In adjusted analyses, SU?+?insulin was associated with increased all-cause mortality (RR 1.81 [1.63, 2.01]), cardiovascular death (RR 1.35 [1.14, 1.60]) and the composite endpoint (RR 1.25 [1.09, 1.42]) compared with metformin?+?insulin. Hypoglycaemia was more frequent with SU?+?insulin than with metformin?+?insulin (17-23 vs six events per 1,000 person-years) and was associated with increased mortality (RR 2.13 [1.97, 2.37]). There were no significant differences in risk between individual SUs in combination with insulin.
In combination with insulin, the use of SUs was associated with increased mortality compared with metformin. There were no significant risk differences between SUs.
Notes
Comment In: Diabetologia. 2015 Jan;58(1):1-325322844
PubMed ID
25205223 View in PubMed
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Temporal trends in the initiation of glucose-lowering medications after a first-time myocardial infarction - a nationwide study between 1997 and 2006.

https://arctichealth.org/en/permalink/ahliterature137795
Source
Cardiovasc Diabetol. 2011;10:5
Publication Type
Article
Date
2011
Author
Mette L Norgaard
Charlotte Andersson
Peter Riis Hansen
Søren S Andersen
Allan Vaag
Tina K Schramm
Fredrik Folke
Lars Køber
Christian Torp-Pedersen
Gunnar H Gislason
Author Affiliation
Department of Cardiology, University Hospital of Copenhagen, Gentofte, Denmark. mlnorgaard@hotmail.com
Source
Cardiovasc Diabetol. 2011;10:5
Date
2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Blood Glucose - drug effects
Denmark - epidemiology
Diabetes Mellitus, Type 2 - blood - drug therapy - epidemiology
Drug Utilization - trends
Female
Health Care Surveys
Hospitalization - trends
Humans
Hypoglycemic agents - therapeutic use
Male
Middle Aged
Myocardial Infarction - epidemiology
Physician's Practice Patterns - trends
Proportional Hazards Models
Registries
Time Factors
Treatment Outcome
Abstract
Type 2 diabetes is a well-established risk factor for cardiovascular disease and is common among patients with acute myocardial infarction (MI). The extent to which patients with first-time MI develop diabetes requiring glucose-lowering medications (GLM) is largely unknown. The aim of the study was to investigate temporal trends in the initiation of GLM among patients discharged after first-time MI.
All Danish residents aged = 30 years without prior diabetes hospitalized with first-time MI between 1997 and 2006 were identified by individual-level-linkage of nationwide registers. Initiation of GLM during follow-up was assessed by claimed prescriptions from pharmacies. Temporal trends in initiation of GLM were assessed by incidence rate calculations in the MI population as in the general population. Multivariable Cox proportional-hazard models were used to investigate the likelihood of initiating GLM within a year post-MI.
The population comprised 66,788 patients. Among these patients 3962 patients initiated GLM, of whom 1567 started within one year post-MI. An increase in incidence rates of GLM initiation in the MI population from 19.6 per 1000 person years in 1997 to approximately 27.6 in 2001 was demonstrated. After 2001 the incidence rates stabilized. A similar trend was observed in the general population where the incidence rates increased from 2.8 in 1997 to 4.0 in 2004 and then stabilized.
Our study demonstrated an increase in incidence rates of GLM initiation within the first year post- MI. A similar trend was observed in the general population suggesting that the increase in GLM among MI patients was primarily the effect of a general increased awareness of diabetes. From a public heath perspective, this study underscores a continuous need for diagnostic and therapeutic improvement in the care of MI patients that develop diabetes.
Notes
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PubMed ID
21247456 View in PubMed
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6 records – page 1 of 1.