Comparative effectiveness of oral antihyperglycemic agents in patients with diabetes and chronic kidney disease
Bibliographic record
Abstract
We sought to compare the safety of sulfonylureas to other oral antihyperglycemic agents (OHAs) in patients with type 2 diabetes (T2DM) and examine whether chronic kidney disease (CKD) is an effect modifier. Using Manitoba Center for Health Policy data, we identified adults with an incident OHA prescription between 2006 and 2016 (monotherapy; add-on to metformin [combotherapy]), and a serum creatinine test. We conducted comparisons with Cox models in propensity score matched cohorts. In 1,777 matched monotherapy pairs, sulfonylureas were associated with all-cause mortality (HR 1.44; 95% CI 1.05 – 1.97) vs. metformin where CKD was an effect modifier (p<0.001) as sulfonylureas performed worse in patients without CKD. In 1,266 matched combotherapy pairs, sulfonylureas were associated with all-cause mortality (HR 2.40; 95% CI 1.15 – 5.02) vs. other OHAs. CKD was not an effect modifier for other comparisons. Our evidence supports metformin as monotherapy, and discourages sulfonylureas as add-on therapy for glycemic control.
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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 | 0.005 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".