A Comparison of Select Cardiovascular Outcomes by Antidiabetic Prescription Drug Classes Used to Treat Type 2 Diabetes Among Military Health System Beneficiaries, Fiscal Year 2003-2006

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Abstract

Background:

Recent research suggests that there is an increased risk of cardiovascular outcomes among individuals with type 2 diabetes taking rosiglitazone (Avandia).

Objective:

To determine if there is an increased incidence of select cardiovascular events, specifically acute myocardial infarction (AMI) and congestive heart failure (CHF), among Military Health System beneficiaries with type 2 diabetes who filled a prescription for Avandia compared with those who filled prescriptions for other antidiabetic medications.

Design:

Cross-sectional analysis of data from fiscal year 2003-2006.

Participants:

Military Health System beneficiaries who are enrolled in TRICARE Prime [Health Maintenance Organization (HMO)-like option] with a diagnosis of type 2 diabetes.

Results:

Average annual incidence of AMI and CHF was lowest among individuals who filled a prescription for biguanides (metformin) and greatest among those who filled a prescription for insulin. The incidence of AMI was highest among beneficiaries with a triple combination of antidiabetic drugs including insulin. The incidence of CHF was highest among those who took a sulfonylurea and Actos during the observation period (fiscal year 2003-2006).

Limitations:

This study has several limitations including the cross-sectional design and inability to make statistical comparisons across drug categories.

Conclusions:

There does not appear to be an increased annual incidence of AMI or CHF among TRICARE Prime beneficiaries with a diagnosis of type 2 diabetes who have filled a prescription for Avandia compared with those who filled prescriptions for other antidiabetic medications.

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