Comparing the effects of biguanides and dipeptidyl peptidase-4 inhibitors on cardio-cerebrovascular outcomes, nephropathy, retinopathy, neuropathy, and treatment costs in diabetic patients

• Published in: PloS one 2024-08, Vol.19 (8), p.e0308734
• Main Authors: Nakatani, Eiji, Ohno, Hiromitsu, Satoh, Tatsunori, Funaki, Daito, Ueki, Chikara, Matsunaga, Taku, Nagahama, Takayoshi, Tonoike, Toru, Yui, Hiromichi, Miyakoshi, Akinori, Tanaka, Yoshihiro, Igarashi, Ataru, Kumamaru, Hiraku, Kuriyama, Nagato, Sugawara, Akira
• Format: Article
• Language: English
• Subjects: Aged; Alcohol use; Analysis; Antidiabetics; Biguanides - economics; Biguanides - therapeutic use; Body mass index; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - economics; Cohort Studies; Coronary vessels; Cost analysis; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - economics; Diabetes therapy; Diabetic Nephropathies - drug therapy; Diabetic Nephropathies - economics; Diabetic Neuropathies - drug therapy; Diabetic Neuropathies - economics; Diabetic neuropathy; Diabetic retinopathy; Diabetic Retinopathy - drug therapy; Diabetic Retinopathy - economics; Diabetics; Dipeptidyl-Peptidase IV Inhibitors - adverse effects; Dipeptidyl-Peptidase IV Inhibitors - economics; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use; Drug therapy; Economic aspects; Female; Health insurance; Humans; Hypertension; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - economics; Hypoglycemic Agents - therapeutic use; Inhibitors; Japan - epidemiology; Kidney diseases; Liver diseases; Male; Middle Aged; Mortality; Nephropathy; Patient outcomes; Patients; Peptidases; Performance evaluation; Peripheral neuropathy; Prescription drugs; Renal failure; Retinopathy; Treatment Outcome; Type 2 diabetes
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0308734

Western guidelines often recommend biguanides as the first-line treatment for diabetes. However, dipeptidyl peptidase-4 (DPP-4) inhibitors, alongside biguanides, are increasingly used as the first-line therapy for type 2 diabetes (T2DM) in Japan. However, there have been few studies comparing the effectiveness of biguanides and DPP-4 inhibitors with respect to diabetes-related complications and cardio-cerebrovascular events over the long term, as well as the costs associated. We aimed to compare the outcomes of patients with T2DM who initiate treatment with a biguanide versus a DPP-4 inhibitor and the long-term costs associated. We performed a cohort study between 2012 and 2021 using a new-user design and the Shizuoka Kokuho database. Patients were included if they were diagnosed with T2DM. The primary outcome was the incidence of cardio-cerebrovascular events or mortality from the initial month of treatment; and the secondary outcomes were the incidences of related complications (nephropathy, renal failure, retinopathy, and peripheral neuropathy) and the daily cost of the drugs used. Individuals who had experienced prior events during the preceding year were excluded, and events within 6 months of the start of the study period were censored. Propensity score matching was performed to compare between two groups. The matched 1:5 cohort comprised 529 and 2,116 patients who were initially treated with a biguanide or a DPP-4 inhibitor, respectively. Although there were no significant differences in the incidence of cardio-cerebrovascular events or mortality and T2DM-related complications between the two groups (p = 0.139 and p = 0.595), daily biguanide administration was significantly cheaper (mean daily cost for biguanides, 61.1 JPY; for DPP-4 inhibitors, 122.7 JPY; p