Thiazolidinediones and reduced risk of incident bacterial abscess in adults with type 2 diabetes: A population-based cohort study

Diabetes Obes Metab. 2018 Dec;20(12):2811-2820. doi: 10.1111/dom.13461. Epub 2018 Aug 7.

Abstract

Aim: Previous research has suggested that peroxisome proliferator-activated receptor-gamma (PPAR-γ) may play an important role in immunomodulation. We aimed to examine the association between thiazolidinediones, PPAR-γ agonists and incidence of bacterial abscess among patients with type 2 diabetes.

Materials and methods: This retrospective cohort study between 2000 and 2010 included 46 986 propensity (PS)-matched patients diagnosed with type 2 diabetes. We compared the incidence of bacterial abscess, including liver and non-liver abscesses, between patients treated with metformin plus a thiazolidinedione (M + T, N = 7831) or metformin plus a sulfonylurea (M + S, N = 39 155). Data were retrieved from a population-based Taiwanese database. We applied Cox proportional hazard regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), comparing M + T and M + S after PS matching.

Results: During a median follow-up of 4.5 years, the incidence rate of bacterial abscess was lower with M + T than with M + S treatment (1.89 vs 3.15 per 1000 person-years) in the PS-matched cohort. M + T was associated with a reduced risk of bacterial abscess (HRs after PS matching, 0.58; 95% CI, 0.42-0.80 for total bacterial abscess; 0.54; 95% CI, 0.28-1.07 for liver abscess; 0.59; 95% CI, 0.41-0.85 for non-liver abscess). Results did not change materially after accounting for unmeasured confounding factors using high-dimenional PS matching and differential censoring between regimen groups. Rosiglitazone and pioglitazone, in combination with metformin, produced similar reductions in risk of all abscess outcomes.

Conclusion: We found that M + T may provide a protective benefit in reducing the incidence of bacterial abscesses. These findings merit further investigation.

Keywords: bacterial abscess; peroxisome proliferator-activated receptor-gamma; population-based study; thiazolidinediones; type 2 diabetes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abscess / epidemiology*
  • Abscess / etiology
  • Abscess / microbiology
  • Adult
  • Aged
  • Databases, Factual
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / microbiology*
  • Drug Therapy, Combination
  • Female
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Incidence
  • Liver Abscess / epidemiology
  • Liver Abscess / etiology
  • Liver Abscess / microbiology
  • Male
  • Metformin / therapeutic use
  • Middle Aged
  • National Health Programs
  • Pioglitazone / therapeutic use
  • Propensity Score
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Rosiglitazone / therapeutic use
  • Sulfonylurea Compounds / therapeutic use
  • Taiwan / epidemiology
  • Thiazolidinediones / therapeutic use*
  • Treatment Outcome

Substances

  • Hypoglycemic Agents
  • Sulfonylurea Compounds
  • Thiazolidinediones
  • Rosiglitazone
  • Metformin
  • Pioglitazone