Differences in Mortality Rate by Anti-hyperglycemic Regimens among Patients in the Thailand Diabetic Registry Project
Thongchai Pratipanawatr MD1, On behalf of the Thailand Diabetic Registry Working Group
Affiliation : 1 Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background : The present study was conducted in order to determine the impact of different regimens of anti-hyperglycemic
agents on all-cause mortality.
Materials and Methods : The Thailand diabetes registry cohort was a prospective 3-year follow-up of the Thai Diabetes
Registry project, registered 9,419 diabetes from 10 diabetic clinics in tertiary medical centers in Bangkok and the major
provinces between April, 2003 and February, 2006. The authors included type 2 diabetic patients over 30 year-old. Patients
whose serum creatinine was >3 mg/dl were excluded to avoid a bias of choosing insulin and metformin. Since few patients
took glinide or alpha-glucosidase inhibitors, our 8,109 (86.09%) patients were classified by their respective regimen of anti-
hyperglycemic agents: i.e., whether sulfonylurea monotherapy (1,151; 14.2%); metformin monotherapy (794; 9.8%);
sulfonylurea combined with metformin (3,665; 45.2%); thiazolidinedione [TZD] monotherapy or combined with anti-
hyperglycemic agents (393; 4.9%); insulin treatment combined with metformin or TZD (1,273; 15.7%); or, insulin treatment
without metformin or TZD (833; 12.6%).
Results : The mortality rate for those who received insulin treatment without metformin or TZD combination (49.3 per 1,000
patient-years) were the highest among anti-hyperglycemic treatment regimens followed by sulfonylurea monotherapy (22.7
per 1,000 patient-years), insulin treatment combined with metformin or TZD (13.6 per 1,000 patient-years), sulfonylurea
combined with metformin (12.2 per 1,000 patient-years), TZD (8.1 per 1,000 patient-years) and metformin monotherapy
(7.0 per 1,000 patient-years). Compared with patients who received sulfonylurea monotherapy, those who received metformin
monotherapy, TZD, sulfonylurea combined with metformin had a respective lower mortality rate of 53% (adjusted hazard
ratio [HR] 0.47 (0.25 to 0.88)), 56% (adjusted HR 0.44 (0.19 to 1.00)), and 31% (adjusted HR 0.69 (0.50 to 0.95)). The
mortality of patients who received insulin treatment without metformin or TZD combination was increased by 53%
(adjusted HR 1.58 (1.10 to 2.28)), while the harmful effects of insulin was reduced when combined with metformin or TZD
(adjusted HR 0.83 (0.53 to 1.29)).
Keywords : Diabetes, Anti-hyperglycemic agents, Metformin, Sulfonylurea, Insulin, Thiazolidinedione, Mortality rate, Death rate
