Association between glycemic control and antidiabetic drugs in type 2 diabetes mellitus patients with cardiovascular complications

Abstract

Purpose: Cardiovascular disease (CVD) is a macrovascular complication in patients with type 2 diabetes mellitus (T2DM). To date, glycemic control profiles of antidiabetic drugs in cardiovascular (CV) complications have not been clearly elucidated. Therefore, this study was conducted retrospectively to assess the association of antidiabetic drugs and glycemic control with CV profiles in T2DM patients. The association of concurrent medications and comorbidities with glycemic control was also investigated.

Methods: A total of 220 T2DM patients from the University of Malaya Medical Centre, Malaysia, who had at least one CV complication and who had been taking at least one antidiabetic drug for at least 3 months, were included. The associations of antidiabetics, cardiovascular diseases, laboratory parameters, concurrent medications, comorbidities, demographics, and clinical characteristics with glycemic control were investigated.

Results: Sulfonylureas in combination (P=0.002) and sulfonylurea monotherapy (P<0.001) were found to be associated with good glycemic control, whereas insulin in combination (P=0.051), and combination biguanides and insulin therapy (P=0.012) were found to be associated with poor glycemic control. Stroke (P=0.044) was the only type of CVD that seemed to be significantly associated with good glycemic control. Other factors such as benign prostatic hyperplasia (P=0.026), elderly patients (P=0.018), low-density lipoprotein cholesterol levels (P=0.021), and fasting plasma glucose (P<0.001) were found to be significantly correlated with good glycemic control.

Conclusion: Individualized treatment in T2DM patients with CVDs can be supported through a better understanding of the association between glycemic control and CV profiles in T2DM patients.

Keywords: antidiabetic drugs; cardiovascular disease; glycemic control; type 2 diabetes mellitus.

Figure 1

Overview of methodology. Abbreviations: UMMC, University of Malaya Medical Centre; T2DM, type 2 diabetes mellitus; ICD-10, International Statistical Classification of Diseases Tenth Revision.

Figure 2

Antidiabetic regimens. Abbreviations: DPP4Is, dipeptidyl peptidase-4 inhibitors; TZDs, thiazolidinediones.

Figure 3

Dosing regimen of biguanides. Abbreviations: MTF, metformin; XR, extended release; OD, once daily; BD, twice daily; ON, every night.

Figure 4

Dosing regimen of sulfonylureas. Abbreviations: OD, once daily; BD, twice daily; MR, modified release; ON, every night.

Figure 5

Dosing regimen of insulin. Abbreviation: S/C, subcutaneous.

Figure 6

Dosing regimen of DPP-4 inhibitors. Abbreviation: DPP-4 inhibitors, dipeptidyl peptidase-4 inhibitors.

Figure 7

Dosing regimen of other antidiabetic regimens.

Figure 8

Comorbidities in T2DM patients with CVDs. Note: Each patient may have more than one comorbidity. Abbreviations: BPH, benign prostate hyperplasia; CVD, cardiovascular disease; T2DM, type 2 diabetes mellitus.

Figure 9

Stage of chronic kidney disease.

Figure 10

Types of liver disease.

Figure 11

Concurrent medications in T2DM patients with cardiovascular disease. Note: Each patient may take more than one concurrent medication. Abbreviations: H2RAs, histamine 2 receptor antagonists; PPIs, proton pump inhibitors; ACEIs, angiotensin converting enzyme inhibitors; ARBs, angiotensin receptor blockers; T2DM, type 2 diabetes mellitus; CCBs, calcium channel blockers.