TY - JOUR
T1 - Incidence of type 2 diabetes mellitus in men receiving steroid 5α-reductase inhibitors
T2 - Population based cohort study
AU - Wei, Li
AU - Lai, Edward Chia Cheng
AU - Kao-Yang, Yea Huei
AU - Walker, Brian R.
AU - MacDonald, Thomas M.
AU - Andrew, Ruth
N1 - Funding Information:
We thank Laurence Stewart (urologist NHS Lothian) and Sarah Wild (professor of epidemiology and honorary consultant in public health) for their helpful peer review of the manuscript. BRW and RA are supported by the Wellcome Trust and British Heart Foundation.
Funding Information:
We thank Laurence Stewart (urologist NHS Lothian) and Sarah Wild (professor of epidemiology and honorary consultant in public health) for their helpful peer review of the manuscript. BRW and RA are supported by the Wellcome Trust and British Heart Foundation. Contributors: RA, LW, BRW, and TMM designed the initial study using CPRD data. LW conducted the statistical analysis and collaborated with Y-HK-Y and EC-CL to explore findings in the Taiwanese dataset. LW and RA prepared the manuscript and all authors reviewed the manuscript. RA is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted Funding: This study was funded by Edinburgh and Lothians Health Foundation. The funder had no role in the design, conduct, or data interpretation of the study. The researchers were independent from the funders, and all authors, external and internal, had full access to all of the data (including statistical reports and tables).
Publisher Copyright:
© Published by the BMJ Publishing Group Limited.
PY - 2019
Y1 - 2019
N2 - Objective To investigate the incidence of new onset type 2 diabetes mellitus in men receiving steroid 5α-reductase inhibitors (dutasteride or finasteride) for long term treatment of benign prostatic hyperplasia. Design Population based cohort study. Setting UK Clinical Practice Research Datalink (CPRD; 2003-14) and Taiwanese National Health Insurance Research Database (NHIRD; 2002-12). Participants Men in the CPRD who received dutasteride (n=8231), finasteride (n=30 774), or tamsulosin (n=16 270) were evaluated. Propensity score matching (2:1; dutasteride to finasteride or tamsulosin) produced cohorts of 2090, 3445, and 4018, respectively. In the NHIRD, initial numbers were 1251 (dutasteride), 4194 (finasteride), and 86 263 (tamsulosin), reducing to 1251, 2445, and 2502, respectively, after propensity score matching. Main outcomes measure Incident type 2 diabetes using a Cox proportional hazard model. Results In the CPRD, 2081 new onset type 2 diabetes events (368 dutasteride, 1207 finasteride, and 506 tamsulosin) were recorded during a mean follow-up time of 5.2 years (SD 3.1 years). The event rate per 10 000 person years was 76.2 (95% confidence interval 68.4 to 84.0) for dutasteride, 76.6 (72.3 to 80.9) for finasteride, and 60.3 (55.1 to 65.5) for tamsulosin. There was a modest increased risk of type 2 diabetes for dutasteride (adjusted hazard ratio 1.32, 95% confidence interval 1.08 to 1.61) and finasteride (1.26, 1.10 to 1.45) compared with tamsulosin. Results for the NHIRD were consistent with the findings for the CPRD (adjusted hazard ratio 1.34, 95% confidence interval 1.17 to 1.54 for dutasteride, and 1.49, 1.38 to 1.61 for finasteride compared with tamsulosin). Propensity score matched analyses showed similar results. Conclusions The risk of developing new onset type 2 diabetes appears to be higher in men with benign prostatic hyperplasia exposed to 5α-reductase inhibitors than in men receiving tamsulosin, but did not differ between men receiving dutasteride and those receiving finasteride. Additional monitoring might be required for men starting these drugs, particularly in those with other risk factors for type 2 diabetes.
AB - Objective To investigate the incidence of new onset type 2 diabetes mellitus in men receiving steroid 5α-reductase inhibitors (dutasteride or finasteride) for long term treatment of benign prostatic hyperplasia. Design Population based cohort study. Setting UK Clinical Practice Research Datalink (CPRD; 2003-14) and Taiwanese National Health Insurance Research Database (NHIRD; 2002-12). Participants Men in the CPRD who received dutasteride (n=8231), finasteride (n=30 774), or tamsulosin (n=16 270) were evaluated. Propensity score matching (2:1; dutasteride to finasteride or tamsulosin) produced cohorts of 2090, 3445, and 4018, respectively. In the NHIRD, initial numbers were 1251 (dutasteride), 4194 (finasteride), and 86 263 (tamsulosin), reducing to 1251, 2445, and 2502, respectively, after propensity score matching. Main outcomes measure Incident type 2 diabetes using a Cox proportional hazard model. Results In the CPRD, 2081 new onset type 2 diabetes events (368 dutasteride, 1207 finasteride, and 506 tamsulosin) were recorded during a mean follow-up time of 5.2 years (SD 3.1 years). The event rate per 10 000 person years was 76.2 (95% confidence interval 68.4 to 84.0) for dutasteride, 76.6 (72.3 to 80.9) for finasteride, and 60.3 (55.1 to 65.5) for tamsulosin. There was a modest increased risk of type 2 diabetes for dutasteride (adjusted hazard ratio 1.32, 95% confidence interval 1.08 to 1.61) and finasteride (1.26, 1.10 to 1.45) compared with tamsulosin. Results for the NHIRD were consistent with the findings for the CPRD (adjusted hazard ratio 1.34, 95% confidence interval 1.17 to 1.54 for dutasteride, and 1.49, 1.38 to 1.61 for finasteride compared with tamsulosin). Propensity score matched analyses showed similar results. Conclusions The risk of developing new onset type 2 diabetes appears to be higher in men with benign prostatic hyperplasia exposed to 5α-reductase inhibitors than in men receiving tamsulosin, but did not differ between men receiving dutasteride and those receiving finasteride. Additional monitoring might be required for men starting these drugs, particularly in those with other risk factors for type 2 diabetes.
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U2 - 10.1136/bmj.l1204
DO - 10.1136/bmj.l1204
M3 - Article
C2 - 30971393
AN - SCOPUS:85064417245
VL - 365
JO - The BMJ
JF - The BMJ
SN - 0959-8146
M1 - l1204
ER -