Table 2. Characteristics of new users of dipeptidyl peptidase-4 inhibitors and biguanides.
| Characteristic | Taiwan | Hong Kong | Japan | United States | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DPP-4 Inhibitor (n = 7497) | Biguanide (n = 48,447) | Std Diff | DPP-4 Inhibitor (n = 530) | Biguanide (n = 2667) | Std Diff | DPP-4 Inhibitor (n = 23,597) | Biguanide (n = 14,004) | Std Diff | DPP-4 Inhibitor (n = 33,420) | Biguanide (n = 76,132) | Std Diff | |
| Men, No. (%) | 3710 (49.5) | 24,615 (50.8) | –0.03 | 249 (47.0) | 1361 (51.0) | 16,987 (72.0) | 9902 (70.7) | 12,622 (37.8) | 30,220 (39.7) | |||
| Age, mean (SD), y | 61.7 (12.7) | 56.6 (14.6) | 0.35 | 63.8 (12.6) | 62.2 (13.1) | 0.12 | 54.3 (9.7) | 51.8 (10.5) | 0.24 | 70.9 (11.8) | 69.1 (11.9) | 0.15 |
| Pattern, No. (%)a | ||||||||||||
| Single use | 431 (5.7) | 25,501 (52.6) | –0.94 | 17 (3.2) | 1676 (62.8) | –1.19 | 8663 (36.7) | 4118 (29.4) | 0.15 | 7662 (22.9) | 48,421 (63.6) | –0.81 |
| Dual use | 2508 (33.5) | 20,242 (41.8) | –0.17 | 91 (17.2) | 906 (34.0) | –0.36 | 7594 (32.2) | 5267 (37.6) | –0.11 | 14,389 (43.1) | 22,333 (29.3) | 0.29 |
| Multiple use | 4558 (60.8) | 2704 (5.6) | 1.64 | 424 (80.0) | 100 (3.7) | 2.06 | 7340 (31.1) | 4619 (33.0) | –0.04 | 11,369 (34.0) | 5378 (7.1) | 0.75 |
| Concurrent antidiabetic medication, No. (%) | ||||||||||||
| Alpha-glucosidase inhibitor | 1285 (17.1) | 1616 (3.3) | 0.62 | 34 (6.4) | 15 (0.6) | 0.47 | 4354 (18.5) | 2691 (19.2) | –0.02 | 296 (0.9) | 169 (0.2) | 0.11 |
| Biguanidine | 4500 (60.0) | — | — | 455 (85.8) | — | — | 6949 (29.4) | — | — | 14,913 (44.6) | — | — |
| DPP-4 inhibitor | — | 220 (0.5) | — | — | 33 (1.2) | — | — | 4774 (34.1) | — | — | 6240 (8.2) | — |
| Insulin | 914 (12.2) | 1520 (3.1) | 0.45 | 109 (20.6) | 172 (6.4) | 0.50 | 2360 (10.0) | 1700 (12.1) | –0.07 | 5705 (17.1) | 8689 (11.4) | 0.17 |
| Meglitinide | 670 (8.9) | 1705 (3.5) | 0.27 | 1 (0.2) | 3 (0.1) | 0.03 | 857 (3.6) | 591 (4.2) | –0.03 | 1137 (3.4) | 755 (1.0) | 0.18 |
| Sulfonylurea | 4519 (60.3) | 19,423 (40.1) | 0.41 | 406 (76.6) | 877 (32.9) | 0.89 | 7020 (29.7) | 4235 (30.2) | –0.01 | 10,678 (32.0) | 14,423 (18.9) | 0.31 |
| Thiazolidinedione | 1319 (17.6) | 1440 (3.0) | 0.67 | 29 (5.5) | 12 (0.4) | 0.45 | 3646 (15.5) | 2003 (14.3) | 0.03 | 6,897 (20.6) | 7107 (9.3) | 0.34 |
| Comorbid conditions, No. (%) | ||||||||||||
| Asthma | 364 (4.9) | 2516 (5.2) | –0.01 | 1 (0.2) | 13 (0.5) | –0.05 | 2157 (9.1) | 1248 (8.9) | 0.01 | 3614 (0.01) | 8673 (11.4) | –0.02 |
| Atrial fibrillation | 162 (2.2) | 641 (1.3) | 0.08 | 10 (1.9) | 24 (0.9) | 0.10 | 491 (2.1) | 197 (1.4) | 0.05 | 4377 (13.1) | 7901 (10.4) | 0.09 |
| COPD | 230 (3.1) | 1831 (3.8) | –0.04 | 1 (0.2) | 20 (0.7) | –0.06 | 2364 (10.0) | 1266 (9.0) | 0.08 | 2261 (6.8) | 5308 (7.0) | –0.01 |
| Dementia | 178 (2.4) | 710 (1.5) | 0.07 | 0 | 12 (0.4) | –0.07 | 74 (0.3) | 21 (0.1) | 0.04 | 1640 (< 0.1) | 3526 (4.6) | 0.01 |
| Depression | 336 (4.5) | 1860 (3.8) | 0.04 | 2 (0.4) | 18 (0.7) | –0.04 | 1204 (5.1) | 692 (4.9) | 0.01 | 2323 (7.0) | 5794 (7.6) | –0.02 |
| Epilepsy | 41 (0.5) | 291 (0.6) | –0.01 | 0 | 2 (0.1) | –0.04 | 366 (1.6) | 212 (1.5) | 0.01 | 553 (1.7) | 1518 (2.0) | –0.02 |
| Heart failure | 444 (5.9) | 1695 (3.5) | 0.13 | 19 (3.6) | 26 (1.0) | 0.22 | 2483 (10.5) | 1252 (8.9) | 0.05 | 7167 (< 0.1) | 11,014 (14.5) | 0.19 |
| Hyperlipidemia | 4098 (54.6) | 17,484 (36.1) | 0.38 | 29 (5.5) | 67 (2.5) | 0.18 | 14,883 (63.1) | 8272 (59.1) | 0.08 | 28,203 (84.4) | 56,871 (74.7) | 0.23 |
| Hypertension | 4368 (58.3) | 20,877 (43.1) | 0.31 | 58 (10.9) | 188 (7.0) | 0.15 | 12,390 (52.5) | 6484 (46.3) | 0.12 | 30,112 (90.1) | 63,172 (83.0) | 0.20 |
| Malignant neoplasm | 436 (5.8) | 1998 (4.1) | 0.08 | 7 (1.3) | 36 (1.3) | 0.00 | 4945 (21.0) | 2680 (19.1) | 0.05 | 4350 (13.0) | 8523 (11.2) | 0.06 |
| Mood disorder | 359 (4.8) | 2047 (4.2) | 0.03 | 2 (0.4) | 18 (0.7) | –0.04 | 1281 (5.4) | 740 (5.3) | 0.00 | 2817 (8.4) | 7423 (9.8) | –0.05 |
| Myocardial infarction | 66 (2.1) | 578 (1.2) | 0.08 | 4 (0.8) | 14 (0.5) | 0.04 | 1040 (4.4) | 536 (3.8) | 0.03 | 813 (2.4) | 1409 (1.9) | 0.04 |
| Parkinson disease | 356 (0.9) | 325 (0.7) | 0.02 | 0 | 5 (0.2) | –0.05 | 109 (0.5) | 48 (0.3) | 0.03 | 470 (1.4) | 938 (1.2) | 0.02 |
| Pneumonia | 54 (4.7) | 1867 (3.9) | 0.04 | 9 (1.7) | 37 (1.4) | 0.03 | 977 (4.1) | 521 (3.7) | 0.02 | 670 (2.0) | 1413 (1.9) | 0.01 |
| Renal failure | 591 (7.9) | 840 (1.7) | 0.39 | 13 (2.5) | 11 (0.4) | 0.24 | 352 (1.5) | 120 (0.9) | 0.05 | 3228 (9.7) | 3138 (4.1) | 0.24 |
| Rheumatoid arthritis | 82 (1.1) | 424 (0.9) | 0.02 | 0 | 0 | — | 713 (3.0) | 342 (2.4) | 0.04 | 1199 (3.6) | 2581 (3.4) | 0.01 |
| Schizophrenia | 54 (0.7) | 439 (0.9) | –0.02 | 0 | 6 (0.2) | –0.05 | 298 (1.3) | 187 (1.3) | 0.00 | 651 (1.9) | 2264 (3.0) | –0.07 |
| Concurrent medications, No. (%) | ||||||||||||
| Anti-arrhythmic | 222 (3.0) | 1071 (2.2) | 0.05 | 7 (1.3) | 9 (0.3) | 0.14 | 3236 (13.7) | 1642 (11.7 | 0.06 | 2103 (6.3) | 3039 (4.0) | 0.11 |
| Antidementia | 191 (2.5) | 861 (1.8) | 0.05 | 4 (0.8) | 12 (0.4) | 0.06 | 33 (0.1) | 7 (< 0.1) | 0.03 | 1790 (5.4) | 3285 (4.3) | 0.05 |
| Antidepressant | 776 (10.4) | 3667 (7.6) | 0.10 | 23 (4.3) | 107 (4.0) | 0.02 | 811 (3.4) | 517 (3.7 | –0.02 | 9762 (29.2) | 22,169 (29.1) | 0.00 |
| Anti-Parkinson | 254 (3.4) | 1770 (3.7) | –0.02 | 1 (0.2) | 44 (1.6) | –0.12 | 154 (0.7) | 75 (0.5) | 0.03 | 1546 (4.6) | 3476 (4.6) | 0.00 |
| Antipsychotic | 553 (7.4) | 3,47 (7.5) | 0.00 | 32 (6.0) | 178 (6.7) | –0.03 | 682 (2.9) | 400 (2.9) | 0.00 | 3010 (9.0) | 8174 (10.7) | –0.06 |
| Benzodiazepine | 1301 (17.4) | 7208 (14.9) | 0.07 | 24 (4.5) | 107 (4.0) | 0.03 | 2583 (10.9) | 1276 (9.1) | 0.06 | 3038 (9.1) | 5681 (7.5) | 0.06 |
| β-Blocker | 2504 (33.4) | 11,854 (24.5) | 0.20 | 192 (36.2) | 613 (23.0) | 0.30 | 2127 (9.0) | 982 (7.0) | 0.07 | 15,455 (46.2) | 28,544 (37.5) | 0.18 |
| Calcium channel blocker | 3278 (43.7) | 14,474 (29.9) | 0.30 | 214 (40.4) | 858 (32.2) | 0.17 | 6081 (25.8) | 2831 (20.2) | 0.13 | 10,195 (30.5) | 18,425 (24.2) | 0.14 |
| COPD medication | 2511 (33.5) | 16,950 (35.0) | –0.03 | 24 (4.5) | 123 (4.6) | 0.00 | 5379 (22.8) | 2936 (21.0) | 0.04 | 9308 (27.9) | 19,914 (26.2) | 0.04 |
| Diuretic | 2537 (33.8) | 8941 (18.5) | 0.38 | 85 (16.0) | 192 (7.2) | 0.31 | 1370 (5.8) | 594 (4.2) | 0.07 | 18,300 (54.8) | 35,105 (46.1) | 0.17 |
| Non-statin lipid-lowering drug | 927 (12.4) | 2766 (5.7) | 0.27 | 29 (5.5) | 46 (1.7) | 0.25 | 1457 (6.2) | 735 (5.2) | 0.04 | 3306 (9.9) | 4966 (6.5) | 0.13 |
| NSAID | 4308 (57.5) | 28,906 (59.7) | –0.04 | 34 (6.4) | 266 (10.0) | –0.12 | 6840 (29.0) | 3721 (26.6) | 0.05 | 7069 (21.2) | 15,362 (20.2) | 0.02 |
| RAS inhibitor | 1117 (14.9) | 5961 (12.3) | 0.08 | 245 (46.2) | 475 (17.8) | 0.68 | 961 (4.1) | 479 (3.4) | 0.04 | 15,111 (45.2) | 27,833 (36.6) | 0.18 |
| Statin | 3215 (42.9) | 6105 (12.6) | 0.81 | 235 (44.3) | 533 (20.0) | 0.57 | 7581 (32.1) | 3715 (26.5) | 0.12 | 21,181 (63.4) | 36,388 (47.8) | 0.31 |
| Vitamin K antagonist | 111 (1.5) | 310 (0.6) | 0.10 | 11 (2.1) | 31 (1.2) | 0.08 | 377 (1.6) | 140 (1.0) | 0.05 | 3029 (9.1) | 5696 (7.5) | 0.06 |
Abbreviations: Std Diff: standardized difference; COPD, chronic obstructive pulmonary disease; DPP-4, dipeptidyl peptidase-4; NSAID, nonsteroidal anti-inflammatory drug; RAS, renin-angiotensin system.
a Single use refers to new use of a DPP-4 inhibitor or biguanidine without concurrent use or initiation of another antidiabetic medication. Dual use refers to new use of a DPP-4 inhibitor or biguanidine with concurrent use or initiation of 1 other antidiabetic medication. Multiple use refers to new use of a DPP-4 inhibitor or biguanidine with concurrent use or initiation of 2 or more other antidiabetic medications.