Pioglitazone increases risk of ischemic heart disease in patients with type 2 diabetes receiving insulin

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM Journal of diabetes and its complications Pub Date : 2024-10-25 DOI:10.1016/j.jdiacomp.2024.108898

Ming-Hang Tsai , Wu-Chien Chien , Hsin-Chung Lin , Chi-Hsiang Chung , Lih-Chyang Chen , Kuo-Yang Huang , Hsin-An Lin

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Abstract

Aim

Studies evaluating the cardiovascular safety of pioglitazone show inconsistent results and ischemic heart disease (IHD) risks associated with different anti-diabetic drugs added to metformin uncontrolled type 2 diabetes mellitus (T2DM) are not assessed. This study aimed to evaluate IHD risk associated with pioglitazone and/or insulin added to patients with metformin uncontrolled T2DM.

Methods

Data were extracted from the National Health Insurance Research Database of Taiwan. A total of 19,952 patients with T2DM uncontrolled on metformin received pioglitazone and/or insulin added to metformin were included.

Results

Compared to those who never received pioglitazone and/or insulin, patients receiving both insulin and pioglitazone had higher cumulative risk of IHD (adjusted HR [aHR] = 1.911, 95 % confidence interval [CI]: 1.506–2.351), pioglitazone alone (aHR = 1.446, 95 % CI: 1.111–1.775), and insulin alone (aHR = 1.351, 95 % CI: 1.1052–1.684) (all, p < 0.05). Patients who received both pioglitazone and insulin had a higher cumulative risk of IHD than those who received insulin or pioglitazone as well as a similar result in the cumulative defined daily dose (cDDD) of the drugs.

Conclusion

Administering pioglitazone plus insulin to patients with T2DM uncontrolled on metformin may increase the risk of IHD, suggesting that other second-line anti-diabetes drugs may be a better choice for patients with T2DM uncontrolled on metformin.

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吡格列酮会增加接受胰岛素治疗的 2 型糖尿病患者罹患缺血性心脏病的风险。

目的：评估吡格列酮心血管安全性的研究显示出不一致的结果，而与二甲双胍未控制的2型糖尿病（T2DM）患者添加不同抗糖尿病药物相关的缺血性心脏病（IHD）风险尚未得到评估。本研究旨在评估在二甲双胍未控制的 2 型糖尿病患者中添加吡格列酮和/或胰岛素的相关 IHD 风险：方法：数据来自台湾国民健康保险研究数据库。结果：与从未服用过吡格列酮和/或胰岛素的 T2DM 患者相比，未服用过吡格列酮和/或胰岛素的 T2DM 患者患高血压的风险更高：结果：与从未接受过吡格列酮和/或胰岛素治疗的患者相比，同时接受胰岛素和吡格列酮治疗的患者发生心肌梗死的累积风险更高（调整后 HR [aHR] = 1.911，95% 置信区间[CI]：1.506-2.351）、单用吡格列酮（aHR = 1.446，95% CI：1.111-1.775）和单用胰岛素（aHR = 1.351，95% CI：1.1052-1.684）的累积风险较高（均为 p 结论：胰岛素和吡格列酮联合使用的累积风险较高：服用二甲双胍未得到控制的 T2DM 患者使用吡格列酮加胰岛素可能会增加罹患高血压的风险，这表明对于服用二甲双胍未得到控制的 T2DM 患者来说，其他二线抗糖尿病药物可能是更好的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of diabetes and its complications 医学-内分泌学与代谢

CiteScore

5.90

自引率

3.30%

发文量

153

审稿时长

16 days

期刊介绍： Journal of Diabetes and Its Complications (JDC) is a journal for health care practitioners and researchers, that publishes original research about the pathogenesis, diagnosis and management of diabetes mellitus and its complications. JDC also publishes articles on physiological and molecular aspects of glucose homeostasis. The primary purpose of JDC is to act as a source of information usable by diabetes practitioners and researchers to increase their knowledge about mechanisms of diabetes and complications development, and promote better management of people with diabetes who are at risk for those complications. Manuscripts submitted to JDC can report any aspect of basic, translational or clinical research as well as epidemiology. Topics can range broadly from early prediabetes to late-stage complicated diabetes. Topics relevant to basic/translational reports include pancreatic islet dysfunction and insulin resistance, altered adipose tissue function in diabetes, altered neuronal control of glucose homeostasis and mechanisms of drug action. Topics relevant to diabetic complications include diabetic retinopathy, neuropathy and nephropathy; peripheral vascular disease and coronary heart disease; gastrointestinal disorders, renal failure and impotence; and hypertension and hyperlipidemia.