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Background@#Although cardiovascular outcome trials using sodium-glucose cotransporter-2 inhibitors (SGLT-2i) showed a reduction in risk of 3-point major adverse cardiovascular events (MACE), they did not demonstrate beneficial effects on stroke risk. Additionally, meta-analysis showed SGLT-2i potentially had an adverse effect on stroke risk. Contrarily, pioglitazone, a type of thiazolidinedione (TZD), has been shown to reduce recurrent stroke risk. Thus, we aimed to compare the effect of SGLT-2i and TZD on the risk of stroke in type 2 diabetes mellitus (T2DM) patients. @*Methods@#Using the Korean National Health Insurance Service data, we compared a 1:1 propensity score-matched cohort of patients who used SGLT-2i or TZD from January 2014 to December 2018. The primary outcome was stroke. The secondary outcomes were myocardial infarction (MI), cardiovascular death, 3-point MACE, and heart failure (HF). @*Results@#After propensity-matching, each group included 56,794 patients. Baseline characteristics were well balanced. During the follow-up, 862 patients were newly hospitalized for stroke. The incidence rate of stroke was 4.11 and 4.22 per 1,000 person-years for the TZD and SGLT-2i groups respectively. The hazard ratio (HR) of stroke was 1.054 (95% confidence interval [CI], 0.904 to 1.229) in the SGLT-2i group compared to the TZD group. There was no difference in the risk of MI, cardiovascular death, 3-point MACE between groups. Hospitalization for HF was significantly decreased in SGLT-2i-treated patients (HR, 0.645; 95% CI, 0.466 to 0.893). Results were consistent regardless of prior cardiovascular disease. @*Conclusion@#In this real-world data, the risk of stroke was comparable in T2DM patients treated with SGLT-2i or TZD.
RESUMO
Background@#Dipeptidyl peptidase-4 inhibitor (DPP-4i) and renin-angiotensin system (RAS) blockade are reported to affect the clinical course of coronavirus disease 2019 (COVID-19) in patients with diabetes mellitus (DM). @*Methods@#As of May 2020, analysis was conducted on all subjects who could confirm their history of claims related to COVID-19 in the National Health Insurance Review and Assessment Service (HIRA) database in Korea. Using this dataset, we compared the short-term prognosis of COVID-19 infection according to the use of DPP-4i and RAS blockade. Additionally, we validated the results using the National Health Insurance Service (NHIS) of Korea dataset. @*Results@#Totally, data of 67,850 subjects were accessible in the HIRA dataset. Of these, 5,080 were confirmed COVID-19. Among these, 832 subjects with DM were selected for analysis in this study. Among the subjects, 263 (31.6%) and 327 (39.3%) were DPP4i and RAS blockade users, respectively. Thirty-four subjects (4.09%) received intensive care or died. The adjusted odds ratio for severe treatment among DPP-4i users was 0.362 (95% confidence interval [CI], 0.135 to 0.971), and that for RAS blockade users was 0.599 (95% CI, 0.251 to 1.431). These findings were consistent with the analysis based on the NHIS data using 704 final subjects. The adjusted odds ratio for severe treatment among DPP-4i users was 0.303 (95% CI, 0.135 to 0.682), and that for RAS blockade users was 0.811 (95% CI, 0.391 to 1.682). @*Conclusion@#This study suggests that DPP-4i is significantly associated with a better clinical outcome of patients with COVID-19.
RESUMO
Purpose@#The aim of this study was to analyze the prevalence of depression, anxiety, somatization disorder, and adjustment disorder in older patients diagnosed with exudative age-related macular degeneration (AMD) and to evaluate the relationship between exudative AMD and psychological disease. @*Methods@#The 2016 Health Insurance Review and Assessment Service-Aged Patient Sample was applied in this study. The subjects were divided into two groups: AMD patients undergoing intravitreal injection treatment and a control group. Comorbidities were evaluated using the Charlson Comorbidity Index. @*Results@#A total of 1,319,052 subjects were selected, of which 3,134 were in the exudative AMD group receiving intravitreal injections. The average age of the subjects was 74.7 ± 6.7 years, and 41.8% were male. In patients with exudative AMD, the prevalence of depression, anxiety, somatization disorder, and adjustment disorder were 16%, 20%, 0.5%, and 0.4%, respectively; in particular, the prevalence of depression and adjustment disorder were significantly higher than in the control group. In multivariate regression analysis, exudative AMD was a significant factor of depression (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.08-1.31, p < 0.001) and adjustment disorder (OR 2.47, 95% CI 1.47-4.18, p < 0.001). However, the association between AMD and anxiety or somatization disorder was not statistically significant. @*Conclusions@#Exudative AMD showed a significant association with psychiatric disease, such as depression, and requires close clinical attention.
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Purpose@#The aim of this study was to analyze the prevalence of depression, anxiety, somatization disorder, and adjustment disorder in older patients diagnosed with exudative age-related macular degeneration (AMD) and to evaluate the relationship between exudative AMD and psychological disease. @*Methods@#The 2016 Health Insurance Review and Assessment Service-Aged Patient Sample was applied in this study. The subjects were divided into two groups: AMD patients undergoing intravitreal injection treatment and a control group. Comorbidities were evaluated using the Charlson Comorbidity Index. @*Results@#A total of 1,319,052 subjects were selected, of which 3,134 were in the exudative AMD group receiving intravitreal injections. The average age of the subjects was 74.7 ± 6.7 years, and 41.8% were male. In patients with exudative AMD, the prevalence of depression, anxiety, somatization disorder, and adjustment disorder were 16%, 20%, 0.5%, and 0.4%, respectively; in particular, the prevalence of depression and adjustment disorder were significantly higher than in the control group. In multivariate regression analysis, exudative AMD was a significant factor of depression (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.08-1.31, p < 0.001) and adjustment disorder (OR 2.47, 95% CI 1.47-4.18, p < 0.001). However, the association between AMD and anxiety or somatization disorder was not statistically significant. @*Conclusions@#Exudative AMD showed a significant association with psychiatric disease, such as depression, and requires close clinical attention.
RESUMO
Background@#Dipeptidyl peptidase-4 inhibitor (DPP-4i) and renin-angiotensin system (RAS) blockade are reported to affect the clinical course of coronavirus disease 2019 (COVID-19) in patients with diabetes mellitus (DM). @*Methods@#As of May 2020, analysis was conducted on all subjects who could confirm their history of claims related to COVID-19 in the National Health Insurance Review and Assessment Service (HIRA) database in Korea. Using this dataset, we compared the short-term prognosis of COVID-19 infection according to the use of DPP-4i and RAS blockade. Additionally, we validated the results using the National Health Insurance Service (NHIS) of Korea dataset. @*Results@#Totally, data of 67,850 subjects were accessible in the HIRA dataset. Of these, 5,080 were confirmed COVID-19. Among these, 832 subjects with DM were selected for analysis in this study. Among the subjects, 263 (31.6%) and 327 (39.3%) were DPP4i and RAS blockade users, respectively. Thirty-four subjects (4.09%) received intensive care or died. The adjusted odds ratio for severe treatment among DPP-4i users was 0.362 (95% confidence interval [CI], 0.135 to 0.971), and that for RAS blockade users was 0.599 (95% CI, 0.251 to 1.431). These findings were consistent with the analysis based on the NHIS data using 704 final subjects. The adjusted odds ratio for severe treatment among DPP-4i users was 0.303 (95% CI, 0.135 to 0.682), and that for RAS blockade users was 0.811 (95% CI, 0.391 to 1.682). @*Conclusion@#This study suggests that DPP-4i is significantly associated with a better clinical outcome of patients with COVID-19.