Effect of antidiabetic medication adherence on risk of all-cause mortality and cardiovascular diseases in type 2 diabetes patients: Impact of antidiabetic adherence on cardiovascular disease.

DPP-4 inhibitor users demonstrated higher adherence and persistence compared to TZD users at 12 months, whereas adherence was comparable between TZD and SU users.

• Adherence was measured using proportion of days covered (PDC) during the first year
• High adherence was defined as PDC ≥0.8
• Data drawn from the Korean National Health Insurance Service (2009-2018)
• Two matched cohorts: TZDs vs DPP-4 inhibitors (n=7875) and TZDs vs SUs (n=5837)

TZD therapy was associated with increased risk of stroke compared with DPP-4 inhibitors in cohort 1.

• HR 1.14, 95% CI: 1.01-1.23 for stroke
• Analysis used Cox proportional hazards models with intention-to-treat and adherence-stratified analyses
• Cohort 1 comprised TZD users vs DPP-4 inhibitor users (n=7875 matched pairs)

TZD therapy was associated with increased all-cause mortality compared with DPP-4 inhibitors in cohort 1.

• HR 1.10, 95% CI: 1.01-1.20 for all-cause mortality
• Analysis was conducted using Cox proportional hazards models
• Cohort 1 comprised matched TZD vs DPP-4 inhibitor users (n=7875)

TZDs were associated with lower risk of myocardial infarction compared with sulfonylureas in cohort 2.

• HR 0.80, 95% CI: 0.65-0.99 for myocardial infarction
• Cohort 2 comprised matched TZD vs SU users (n=5837)
• Analysis used Cox proportional hazards models with intention-to-treat and adherence-stratified analyses

TZDs were associated with lower risk of major adverse cardiovascular events compared with sulfonylureas in cohort 2.

• HR 0.85, 95% CI: 0.76-0.95 for major adverse CV events (MACE)
• Cohort 2 comprised matched TZD vs SU users (n=5837)
• MACE was one of several CV outcomes examined including myocardial infarction, stroke, CV death, and hospitalization for heart failure

TZDs were associated with lower risk of hospitalization for heart failure compared with sulfonylureas in cohort 2.

• HR 0.86, 95% CI: 0.75-1.00 for hospitalization for heart failure
• Cohort 2 comprised matched TZD vs SU users (n=5837)

TZDs were associated with lower all-cause mortality compared with sulfonylureas in cohort 2.

• HR 0.83, 95% CI: 0.74-0.93 for all-cause mortality
• Cohort 2 comprised matched TZD vs SU users (n=5837)
• Cox proportional hazards models were applied using intention-to-treat and adherence-stratified analyses

High adherence to TZDs was consistently associated with more favorable cardiovascular and survival outcomes in comparison to sulfonylureas.

• High adherence defined as PDC ≥0.8 during first year of treatment
• Adherence-stratified analyses were performed in addition to intention-to-treat analyses
• The favorable association was consistent across CV and mortality outcomes in the TZD vs SU cohort