Evidence map›Paper›PMID 36866496›Full record

ArticleThe journals of gerontology. Series A, Biological sciences and medical sciences2023

Risk of Severe Hypoglycemia With Newer Second-line Glucose-lowering Medications in Older Adults With Type 2 Diabetes Stratified by Known Indicators of Hypoglycemia Risk.

Phyo T Htoo, Julie M Paik, Ethan Alt, Dae Hyun Kim, Deborah J Wexler, Seoyoung C Kim, Elisabetta Patorno

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The journals of gerontology. Series A, Biological sciences and medical sciences, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
1.8field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it, 9 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Article
  5. Article
  6. Article
  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Phyo T HtooDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.ORCID 0000-0003-4742-8306
Julie M PaikDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.ORCID 0000-0002-1315-5445
Ethan AltDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.ORCID 0000-0002-6112-9030
Dae Hyun KimMarcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA.ORCID 0000-0001-7290-6838
Deborah J WexlerMassachusetts General Hospital Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA.
Seoyoung C KimDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Elisabetta PatornoDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Brigham and Women's Hospital · USHarvard University · US

Funding

Enhancing evidence generation by linking randomized clinical trials (RCTs) to real world data (RWD)U01FD007213 · FDA · BRIGHAM AND WOMEN'S HOSPITAL · PI PATORNO, ELISABETTA · 2020 to 2022
$4.2M
Mid-Career Mentoring Award For Patient-Oriented Research in Frailty and Health OutcomesK24AG073527 · NIA · HEBREW REHABILITATION CENTER FOR AGED · PI Dae Hyun Kim · 2022 to 2026
$862k
Novel Approaches to Monitor the Safety and Effectiveness of Newly Marketed Diabetes Medications in Older Adults Considering Frailty and MultimorbidityK08AG055670 · NIA · BRIGHAM AND WOMEN'S HOSPITAL · PI PATORNO, ELISABETTA · 2018 to 2021
$661k
Planning for Long Term Care--Pilot Data CollectionR03AG020326 · NIA · FLORIDA INTERNATIONAL UNIVERSITY · PI DUNLOP, BURTON D · 2001 to 2001
$69k
FDA HHS 5U01FD007213FDA HHS U01 FD007213NIA NIH HHS DB-2020C2-20326NIA NIH HHS K08 AG055670NIA NIH HHS K24 AG073527NIDDK NIH HHS 4-22-PDFPM-15Patient-Centered Outcomes Research Institute
6 · The paper itself

Abstract

backgroundSevere hypoglycemia is associated with adverse clinical outcomes. We evaluated the risk of severe hypoglycemia in older adults initiating newer glucose-lowering medications overall and across strata of known indicators of high hypoglycemia risk.

methodsWe conducted a comparative-effectiveness cohort study of older adults aged >65 years with type 2 diabetes initiating sodium-glucose cotransporter 2 inhibitors (SGLT2i) versus dipeptidyl peptidase-4 inhibitors (DPP-4i) or SGLT2i versus glucagon-like peptide-1 receptor agonists (GLP-1RA) using Medicare claims (3/2013-12/2018) and Medicare-linked-electronic health records. We identified severe hypoglycemia requiring emergency or inpatient visits using validated algorithms. After 1:1 propensity score matching, we estimated hazard ratios (HR) and rate differences (RD) per 1,000 person-years. Analyses were stratified by baseline insulin, sulfonylurea, cardiovascular disease (CVD), chronic kidney disease (CKD), and frailty.

resultsOver a median follow-up of 7 (interquartile range: 4-16) months, SGLT2i was associated with a reduced risk of hypoglycemia versus DPP-4i (HR 0.75 [0.68, 0.83]; RD -3.21 [-4.29, -2.12]), and versus GLP-1RA (HR 0.90 [0.82, 0.98]; RD -1.33 [-2.44, -0.23]). RD for SGLT2i versus DPP-4i was larger in patients using baseline insulin than in those not, although HRs were similar. In patients using baseline sulfonylurea, the risk of hypoglycemia was lower in SGLT2i versus DPP-4i (HR 0.57 [0.49, 0.65], RD -6.80 [-8.43, -5.16]), while the association was near-null in those without baseline sulfonylurea. Results stratified by baseline CVD, CKD and frailty were similar to the overall cohort findings. Findings for the GLP-1RA comparison were similar.

conclusionsSGLT2i was associated with a lower hypoglycemia risk versus incretin-based medications, with larger associations in patients using baseline insulin or sulfonylurea.

Indexed as

Cardiovascular DiseasesDiabetes Mellitus, Type 2Dipeptidyl-Peptidase IV InhibitorsFrailtyHypoglycemiaRenal Insufficiency, ChronicAgedCohort StudiesGlucoseHumansHypoglycemic AgentsInsulinMedicareSulfonylurea CompoundsUnited StatesDipeptidyl-Peptidase IV InhibitorsGlucoseHypoglycemic AgentsInsulinSulfonylurea CompoundsComparative effectivenessDrug safetyGLP-1RAHypoglycemiaIncretin-based medicationsSGLT2 inhibitors

Identifiers

PMID36866496
PMCPMC10692415
OpenAlexW4323036937

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.