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