| Summary: | 碩士 === 中國醫藥大學 === 藥學系碩士班 === 104 === Background
Atrial fibrillation (AF) is a common heart rhythm disorder, it is a major risk factor for ischemic stroke, AF-induced stroke often cause severe neurological symptoms and even death.
Increasingly, evidences have suggested that inflammation or the generation of reactive oxygen species (ROS) are involved with the pathogenesis of AF. Diabetes mellitus (DM) is one of the major risk factor of AF, there are a lot of literatures demonstrated that inflammation is a common pathogenesis of AF associated with DM.
The uses of antihyperglycemic drugs are very common in Taiwan, many studies showed that antihyperglycemic effects can reduce inflammation in diabetic patients. Therefore, the purpose of this study is to assess the associations with the treatment of antihyperglycemic drugs and the occurrence of AF in the DM patients.
Objective
To investigate the relationship between different types of antihyperglycemic drugs use and the risk of new-onset AF for DM patients.
Method
This case-control study used the “Longitudinal Cohort of Diabetes Patients Database (LHDB) 2002-2013,” which was released by the Taiwan National Health Research Institutes for research purposes. The data file that contains inpatient expenditures by admissions (DD), details of inpatient orders (DO), ambulatory care expenditures by visits (CD), details of ambulatory care orders (OO), and secondary data analysis carried out after capturing the desired variables. First, the patients with diabetes were identified according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 250.XX. To ensure the diagnostic validity and avoid any potential for misclassifications, only the patients with at least 2 consensus diabetes diagnoses were selected.
Diabetes patients with AF (ICD-9-CM code 427.31) are the case group, and patients with AF of undiagnosed are the control group, index date is derived from registry for drug prescriptions database. We evaluated the odds ratio of using antihyperglycemic drugs related to new-onset AF and non-new-onset AF (control group). This study use SAS 9.4 statistical software to perform conditional logistic regression models.
Result
In the study, there are 14410 patients who were DM, after adjusting for age, sex, co-morbidities and medications, the results show that biguanide independently protected the diabetic patients from new-onset AF with a odds ratio of 0.81 (95% confidence interval (95% CI) 0.71-0.95), Thiazolidinedione can reduce with a odds ratio of 28% (95% CI 0.63-0.83), Insulin can increase with a odds ratio of 19% (95% CI 1.06-1.35). As a result, Thiazolidinedione is the first choice among seven categories hypoglycemic drugs; biguanide comes second.
Conclusion
In the case-control study, we demonstrated that patients with DM can use thiazolidinedione and biguanide to protected diabetic patients from new-onset AF.
Key words
Diabetes mellitus, new-onset atrial fibrillation, Antihyperglycemic Drugs, National health insurance research database, case-control study
|
|---|
