Thiazolidinediones and reduced risk of incident bacterial abscess in adults with type 2 diabetes: A population-based cohort study.

Jiun-Ling Wang, Yaa-Hui Dong, Wen-Chien Ko, Chia-Hsuin Chang, Li-Chiu Wu, Lee-Ming Chuang, Pau-Chung Chen

REVIEW


30 October 2018

An innovative area in which little is known.  However, this study is unlikely to have much impact on clinical decision making.


RELEVANCE 2
INNOVATIVENESS 4
APPLICABILITY 2
OVERALL 3

PAPER DETAILS


TITLE

Thiazolidinediones and reduced risk of incident bacterial abscess in adults with type 2 diabetes: A population-based cohort study.

ABSTRACT

AIM
Previous research has suggested that peroxisome proliferator-activated receptor-gamma (PPAR-γ) may play an important role in immunomodulation. We aimed to examine the association between thiazolidinediones, PPAR-γ agonists and incidence of bacterial abscess among patients with type 2 diabetes.

MATERIALS AND METHODS
This retrospective cohort study between 2000 and 2010 included 46 986 propensity (PS)-matched patients diagnosed with type 2 diabetes. We compared the incidence of bacterial abscess, including liver and non-liver abscesses, between patients treated with metformin plus a thiazolidinedione (M + T, N = 7831) or metformin plus a sulfonylurea (M + S, N = 39 155). Data were retrieved from a population-based Taiwanese database. We applied Cox proportional hazard regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), comparing M + T and M + S after PS matching.

RESULTS
During a median follow-up of 4.5 years, the incidence rate of bacterial abscess was lower with M + T than with M + S treatment (1.89 vs 3.15 per 1000 person-years) in the PS-matched cohort. M + T was associated with a reduced risk of bacterial abscess (HRs after PS matching, 0.58; 95% CI, 0.42-0.80 for total bacterial abscess; 0.54; 95% CI, 0.28-1.07 for liver abscess; 0.59; 95% CI, 0.41-0.85 for non-liver abscess). Results did not change materially after accounting for unmeasured confounding factors using high-dimenional PS matching and differential censoring between regimen groups. Rosiglitazone and pioglitazone, in combination with metformin, produced similar reductions in risk of all abscess outcomes.

CONCLUSION
We found that M + T may provide a protective benefit in reducing the incidence of bacterial abscesses. These findings merit further investigation.



AUTHOR(S)

Jiun-Ling Wang, Yaa-Hui Dong, Wen-Chien Ko, Chia-Hsuin Chang, Li-Chiu Wu, Lee-Ming Chuang, Pau-Chung Chen,

JOURNAL

Diabetes, obesity & metabolism

PLACE

England