Comparative effectiveness of oral antihyperglycemic agents in patients with diabetes and chronic kidney disease

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dc.contributor.authorWhitlock, Reid
dc.contributor.examiningcommitteeNickel, Nathan (Community Health Sciences) Pitz, Marshall (Internal Medicine) Komenda, Paul (Internal Medicine) Clemens, Kristin (Western University)en_US
dc.contributor.supervisorTangri, Navdeep (Community Health Sciences)en_US
dc.date.accessioned2018-06-14T15:13:06Z
dc.date.available2018-06-14T15:13:06Z
dc.date.issued2018en_US
dc.date.submitted2018-05-14T15:14:59Zen
dc.degree.disciplineCommunity Health Sciencesen_US
dc.degree.levelMaster of Science (M.Sc.)en_US
dc.description.abstractWe sought to compare the safety of sulfonylureas to other oral antihyperglycemic agents (OHAs) in patients with type 2 diabetes (T2DM) and examine whether chronic kidney disease (CKD) is an effect modifier. Using Manitoba Center for Health Policy data, we identified adults with an incident OHA prescription between 2006 and 2016 (monotherapy; add-on to metformin [combotherapy]), and a serum creatinine test. We conducted comparisons with Cox models in propensity score matched cohorts. In 1,777 matched monotherapy pairs, sulfonylureas were associated with all-cause mortality (HR 1.44; 95% CI 1.05 – 1.97) vs. metformin where CKD was an effect modifier (p<0.001) as sulfonylureas performed worse in patients without CKD. In 1,266 matched combotherapy pairs, sulfonylureas were associated with all-cause mortality (HR 2.40; 95% CI 1.15 – 5.02) vs. other OHAs. CKD was not an effect modifier for other comparisons. Our evidence supports metformin as monotherapy, and discourages sulfonylureas as add-on therapy for glycemic control.en_US
dc.description.noteOctober 2018en_US
dc.identifier.urihttp://hdl.handle.net/1993/33051
dc.language.isoengen_US
dc.rightsopen accessen_US
dc.subjecttype 2 diabetesen_US
dc.subjectCKDen_US
dc.subjectOHAen_US
dc.subjectsulfonylureasen_US
dc.titleComparative effectiveness of oral antihyperglycemic agents in patients with diabetes and chronic kidney diseaseen_US
dc.typemaster thesisen_US
local.subject.manitobayesen_US
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