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Benefits and harms of antidiabetic agents in patients with diabetes and heart failure: systematic review

BMJ, 2007-09, Vol.335 (7618), p.497-501 [Peer Reviewed Journal]

BMJ Publishing Group Ltd 2007 ;Copyright 2007 BMJ Publishing Group Ltd. ;2007 INIST-CNRS ;Copyright: 2007 (c) BMJ Publishing Group Ltd 2007 ;BMJ Publishing Group Ltd 2007 2007 BMJ Publishing Group Ltd ;ISSN: 0959-8138 ;ISSN: 0959-8146 ;EISSN: 1468-5833 ;EISSN: 1756-1833 ;DOI: 10.1136/bmj.39314.620174.80 ;PMID: 17761999 ;CODEN: BMJOAE

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Title:
Benefits and harms of antidiabetic agents in patients with diabetes and heart failure: systematic review
Author: Eurich, Dean T ; McAlister, Finlay A ; Blackburn, David F ; Majumdar, Sumit R ; Tsuyuki, Ross T ; Varney, Janice ; Johnson, Jeffrey A
Subjects: Biological and medical sciences ; Cardiology. Vascular system ; Clinical trials ; Diabetes ; Diabetes. Impaired glucose tolerance ; Diabetic Angiopathies - drug therapy ; Diabetic Angiopathies - mortality ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Experimentation ; General aspects ; Health outcomes ; Heart ; Heart attacks ; Heart failure ; Heart Failure - drug therapy ; Heart Failure - mortality ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Hospital admissions ; Humans ; Hypoglycemic agents ; Hypoglycemic Agents - therapeutic use ; Insulin ; Medical sciences ; Morbidity ; Mortality ; Patients ; Randomized Controlled Trials as Topic ; Studies ; Thiazolidinediones ; Type 2 diabetes mellitus
Is Part Of: BMJ, 2007-09, Vol.335 (7618), p.497-501
Description: Objective To review the literature on the association between antidiabetic agents and morbidity and mortality in people with heart failure and diabetes.Design Systematic review and meta-analysis of controlled studies (randomised trials or cohort studies) evaluating antidiabetic agents and outcomes (death and admission to hospital) in patients with heart failure and diabetes.Data sources Electronic databases, manual reference search, and contact with investigators.Review methods Two reviewers independently extracted data. Risk estimates for specific treatments were abstracted and pooled estimates derived by meta-analysis where appropriate.Results Eight studies were included. Three of four studies found that insulin use was associated with increased risk for all cause mortality (odds ratio 1.25, 95% confidence interval 1.03 to 1.51; 3.42, 1.40 to 8.37 in studies that did not adjust for diet and antidiabetic drugs; hazard ratio 1.66, 1.20 to 2.31; 0.96, 0.88 to 1.05 in the studies that did). Metformin was associated with significantly reduced all cause mortality in two studies (hazard ratio 0.86, 0.78 to 0.97) compared with other antidiabetic drugs and insulin; 0.70, 0.54 to 0.91 compared with sulfonylureas); a similar trend was seen in a third. Metformin was not associated with increased hospital admission for any cause or for heart failure specifically. In four studies, use of thiazolidinediones was associated with reduced all cause mortality (pooled odds ratio 0.83, 0.71 to 0.97, I2=52%, P=0.02). Thiazolidinediones were associated with increased risk of hospital admission for heart failure (pooled odds ratio 1.13 (1.04 to 1.22), I2=0%, P=0.004). The two studies of sulfonylureas had conflicting results, probably because of differences in comparator treatments. Important limitations were noted in all studies.Conclusion Metformin was the only antidiabetic agent not associated with harm in patients with heart failure and diabetes. It was associated with reduced all cause mortality in two of the three studies.
Publisher: London: British Medical Journal Publishing Group
Language: English
Identifier: ISSN: 0959-8138
ISSN: 0959-8146
EISSN: 1468-5833
EISSN: 1756-1833
DOI: 10.1136/bmj.39314.620174.80
PMID: 17761999
CODEN: BMJOAE
Source: AUTh Library subscriptions: ProQuest Central
MEDLINE
Alma/SFX Local Collection

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Benefits and harms of antidiabetic agents in patients with diabetes and heart failure: systematic review

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