Diabetes Week: Mortality in Diabetes and DPP-4 Inhibitors Compared to Sulfonylureas

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This week, Amol, general internal resident at the University of Toronto, and Reena, General Internist at St. Michael’s Hospital in Toronto, discuss two papers:

Reena shares a large registry-based study that found adult patients with Type 2 Diabetes in Sweden had a 15% higher mortality rate than the general population. Amol and Reena wonder why this number is much lower than those reported by other studies in the last 15 years. Could this be due to higher uptake of evidence based therapeutics? Or could it be attributed to Swedish residents having better social determinants of health?

A large observational study found that when combined with metformin, DPP-4 inhibitors are superior to sulfonylureas in treating patients with Type 2 Diabetes. Although a propensity matched analysis was performed, Amol discusses the potential for bias due to unmeasured confounders. In light of these findings and limitations, would Reena and Amol change their practice?

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The papers

1. Diabetes and mortality: http://www.nejm.org/doi/full/10.1056/NEJMoa1504347

2. DPP-4 inhibitors and sulfonylureas: http://annals.org/article.aspx?articleid=2456123

Good Stuff

Music Credits (Creative Commons)

In your Robotic Heart – Nicolai Heidlas https://soundcloud.com/nicolai-heidlas/in-your-robotic-heart

Drive – Nicolai Heidlas https://soundcloud.com/nicolai-heidlas/drive-fresh-upbeat-pop-background-music

Swingin’ Jazz – Nicolai Heidlas ‎https://m.soundcloud.com/nicolai-heidlas/jazz-blues-background-music

All tracks have been modified for the purposes of this podcast.

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  1. T Marshall

    Was the socioeconomic demographic equal between the SU and DDP4 groups. Cost of these drugs may influence who is prescribed and able to continue on them. This could confound health outcomes between groups.

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