1136-P: A Population-Based Assessment of the Risk of Severe Hypoglycemia with Concomitant Use of Sulfonylureas and Peptidomimetic Dipeptidyl Peptidase-4 Inhibitors
Bibliographic record
Abstract
Background: Dipeptidyl peptidase-4 inhibitors (DPP-4i) interact with sulfonylureas (SU) to increase their risk of hypoglycemia. However, it is unclear whether this risk varies with the pharmacologic properties of DPP-4i. Thus, we compared the risk of severe hypoglycemia between concomitant use of SU and peptidomimetic DPP-4i (vildagliptin, saxagliptin) vs. non-peptidomimetic DPP-4i (sitagliptin, linagliptin, alogliptin) in patients with type 2 diabetes. Methods: We conducted a retrospective cohort study using the UK's Clinical Practice Research Datalink linked to hospitalization and vital statistics data of patients with type 2 diabetes initiating SU between 20 and 2020. Time-dependent Cox models estimated hazard ratios (HR) with 95% confidence intervals (CI) of severe hypoglycemia associated with current concomitant use of SU and peptidomimetic DPP-4i compared to current concomitant use of SU and non-peptidomimetic DPP-4i, adjusted for baseline confounders. Secondary analyses stratified by age (<65 vs. ≥65 years) and sex. Results: Our cohort included 196,138 SU initiators. The crude incidence rate of severe hypoglycemia was 7.2 per 1000/year. Compared to concomitant use of SU and non-peptidomimetic DPP-4i, concomitant use of SU and peptidomimetic DPP-4i was not associated with the risk of severe hypoglycemia (HR, 0.96; 95% CI, 0.76-1.22) . In female patients, concomitant use of SU and peptidomimetic DPP-4i was associated with a trend towards an increased risk (HR, 1.32; 95% CI, 0.97-1.81) ; in male patients, there was an association with a decreased risk (HR, 0.69; 95% CI, 0.48-0.99) . Age did not modify the association. Conclusion: Our population-based study showed no increased risk of severe hypoglycemia with concomitant use of SU and peptidomimetic DPP-4i compared to concomitant use of SU and non-peptidomimetic DPP-4i. Further research is needed to corroborate the observed effect modification by sex. Disclosure J.Dimakos: None. Y.Cui: None. R.W.Platt: Consultant; Amgen Inc., Biogen, Merck & Co., Inc., Nant Pharma, Pfizer Inc. C.Renoux: None. K.B.Filion: None. A.Douros: None. Funding Canadian Institutes of Health Research (PJT-165882)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".