Timing of Antidiabetic Medication Initiation and Risk of Cardiovascular Events and Mortality
Rattachement africain : kr, us, ca. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Importance: Among individuals who meet the diagnostic threshold for type 2 diabetes (T2D), timely initiation of antidiabetic medication (ADM) is essential for lowering long-term cardiovascular risk. Objective: To estimate the association between ADM initiation timing-specifically within 3, 6, or 12 months-and the risk of major adverse cardiovascular events (MACE) and all-cause mortality among individuals newly meeting diagnostic criteria for T2D. Design, Setting, and Participants: This cohort study used target trial emulation to analyze health screening data linked to health insurance claims in Korea (2013-2022) using a clone-censor-weight approach. Participants were adults with newly detected glycated hemoglobin (HbA1c) of 6.5% or greater or fasting plasma glucose of 126 mg/dL or greater. Data analysis was conducted from January to August 2025. Exposures: Eligible participants were cloned into 4 treatment strategies: ADM initiation within 3, 6, or 12 months or no initiation within 12 months (strategy 1, 2, 3, and control, respectively). Main outcomes and Measures: Five-year absolute risk difference (RD) and risk ratio (RR) of 3-point MACE (stroke, myocardial infarction, and all-cause mortality) and all-cause mortality were estimated using Kaplan-Meier survival probabilities along with 95% CIs from 1000-sample nonparametric bootstrapping. Results: A total of 23 452 eligible participants (mean [SD] age, 48.2 [11.1] years; 5790 [24.7%] female; mean [SD] HbA1c, 6.9% [1.1%]) were cloned into 4 treatment strategies. Earlier ADM initiation compared with the control showed progressively lower point estimates for 3-point MACE (RR, 0.32; 95% CI, 0.15 to 1.11 for strategy 1; RR, 0.65; 95% CI, 0.41 to 1.29 for strategy 2; RR, 0.93; 95% CI, 0.70 to 1.41 for strategy 3), though it did not achieve statistical significance. Corresponding RDs were -0.97% (95% CI, -1.26% to 0.14%), -0.49% (-0.84% to 0.40%), and -0.10% (-0.44% to 0.57%), respectively. ADM initiation within 3 months yielded significant risk reduction for all-cause mortality compared with the control in both relative (RR, 0.31; 95% CI, 0.10-0.98) and absolute (RD, -0.40%; 95% CI, -0.57% to -0.01%) scales. Conclusions and Relevance: In this cohort study, earlier ADM initiation following the diagnostic threshold for T2D showed a lower risk of mortality, suggesting a potential cardiovascular benefit of early glycemic control; however, given the low event counts and the observational nature of the study, further evaluation in larger studies is warranted before definitive conclusions can be drawn.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Timing of Antidiabetic Medication Initiation and Risk of Cardiovascular Events and Mortality
- Date Crossref
- 22/06/2026
- Éditeur
- American Medical Association (AMA)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Sungkyunkwan University Department of Biohealth Regulatory Science pays non établi dans la noticeUniversité ou école supérieure
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Samsung (South Korea) pays non établi dans la noticeEntreprise
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Brigham and Women's Hospital Department of Medicine pays non établi dans la noticeÉtablissement de santé
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Harvard University pays non établi dans la noticeUniversité ou école supérieure
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McGill University pays non établi dans la noticeUniversité ou école supérieure
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Chonnam National University pays non établi dans la noticeUniversité ou école supérieure
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Seoul National University Department of Internal Medicine pays non établi dans la noticeUniversité ou école supérieure
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Seoul National University Hospital pays non établi dans la noticeÉtablissement de santé
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Kangbuk Samsung Hospital pays non établi dans la noticeÉtablissement de santé
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School of Pharmacy pays non établi dans la noticeUniversité ou école supérieure
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Faculty of Medicine and Health Sciences Gerald Bronfman Department of Oncology pays non établi dans la noticeUniversité ou école supérieure
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College of Pharmacy pays non établi dans la noticeUniversité ou école supérieure
Department of Biohealth Regulatory Science — Sungkyunkwan University, Samsung (South Korea) et Department of Medicine — Brigham and Women's Hospital, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.