The DPP-4 Inhibitor Vildagliptin Is Linked to Fewer Microvascular Complications Than Sulfonylureas
June 6, 2015—Boston, Massachusetts—Treatment of type 2 diabetes with vildagliptin was associated with a lower incidence of microvascular complications, especially neuropathy and retinopathy, than treatment with a sulfonylurea.
This finding, reported at the American Diabetes Association’s 75th Scientific Sessions from June 5–9, 2015, is the result of a retrospective cohort study.
According to Matthew Hankins, PhD, IMS Health, London, UK, preliminary data suggest that dipeptidyl peptidase-4 (DPP-4) inhibitors may lower the incidence of microvascular events. However, few adequate, real-world data exist to support the relationship between reduced microvascular events and DPP-4 inhibitors.
Dr. Hankins and colleagues compared microvascular outcomes between patients prescribed vildagliptin and those prescribed a sulfonylurea in a large sample from a German electronic medical records database.
Exposure was defined as sulfonylurea or vildagliptin therapy. Primary outcome measures were a new diagnosis of retinopathy, nephropathy, neuropathy, or diabetic foot ulcer. A secondary outcome was a composite of any primary outcomes during the observation period.
A total of 16,321 patients taking a sulfonylurea and 4481 taking vildagliptin were included. After propensity score matching, 3015 patients were included per sample.
Mean patient age was 63.7/64.6 years for sulfonylurea/vildagliptin, respectively; mean disease duration was 3.2/3.1 years; and mean treatment duration was 2.5/2.3 years.
Vildagliptin was associated with a significantly lower incidence of retinopathy (OR, 0.55; P = .0004), neuropathy (OR, 0.71; P = .001), and the composite outcome (OR, 0.70; P < .0001).
The incidences of nephropathy and diabetic foot ulcer were lower, although not significantly, for vildagliptin (OR, 0.90 and 0.76, respectively). No significant differences were observed in incident rate ratios.
Dr. Hankins concluded that vildagliptin was linked to a reduced incidence of microvascular complications, especially neuropathy and retinopathy, vs a sulfonylurea, in this cohort of patients with type 2 diabetes.
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