{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:46:23Z","timestamp":1790196383959,"version":"4.1.0"},"reference-count":38,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Among individuals who meet the diagnostic threshold for type 2 diabetes (T2D), timely initiation of antidiabetic medication (ADM) is essential for lowering long-term cardiovascular risk.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To estimate the association between ADM initiation timing\u2014specifically within 3, 6, or 12 months\u2014and the risk of major adverse cardiovascular events (MACE) and all-cause mortality among individuals newly meeting diagnostic criteria for T2D.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n \n This cohort study used target trial emulation to analyze health screening data linked to health insurance claims in Korea (2013-2022) using a clone-censor-weight approach. Participants were adults with newly detected glycated hemoglobin (HbA\n 1c<\/jats:sub>\n ) of 6.5% or greater or fasting plasma glucose of 126 mg\/dL or greater. Data analysis was conducted from January to August 2025.\n <\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Eligible participants were cloned into 4 treatment strategies: ADM initiation within 3, 6, or 12 months or no initiation within 12 months (strategy 1, 2, 3, and control, respectively).<\/jats:p>\n <\/jats:sec>\n \n Main outcomes and Measures<\/jats:title>\n Five-year absolute risk difference (RD) and risk ratio (RR) of 3-point MACE (stroke, myocardial infarction, and all-cause mortality) and all-cause mortality were estimated using Kaplan-Meier survival probabilities along with 95% CIs from 1000-sample nonparametric bootstrapping.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 23\u202f452 eligible participants (mean [SD] age, 48.2 [11.1] years; 5790 [24.7%] female; mean [SD] HbA\n 1c<\/jats:sub>\n , 6.9% [1.1%]) were cloned into 4 treatment strategies. Earlier ADM initiation compared with the control showed progressively lower point estimates for 3-point MACE (RR, 0.32; 95% CI, 0.15 to 1.11 for strategy 1; RR, 0.65; 95% CI, 0.41 to 1.29 for strategy 2; RR, 0.93; 95% CI, 0.70 to 1.41 for strategy 3), though it did not achieve statistical significance. Corresponding RDs were \u22120.97% (95% CI, \u22121.26% to 0.14%), \u22120.49% (\u22120.84% to 0.40%), and \u22120.10% (\u22120.44% to 0.57%), respectively. ADM initiation within 3 months yielded significant risk reduction for all-cause mortality compared with the control in both relative (RR, 0.31; 95% CI, 0.10-0.98) and absolute (RD, \u22120.40%; 95% CI, \u22120.57% to \u22120.01%) scales.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study, earlier ADM initiation following the diagnostic threshold for T2D showed a lower risk of mortality, suggesting a potential cardiovascular benefit of early glycemic control; however, given the low event counts and the observational nature of the study, further evaluation in larger studies is warranted before definitive conclusions can be drawn.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.19362","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T15:30:39Z","timestamp":1782142239000},"page":"e2619362","source":"Crossref","is-referenced-by-count":1,"title":["Timing of Antidiabetic Medication Initiation and 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Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea"},{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo Heon","family":"Kwak","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea"},{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Min","family":"Cho","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea"},{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ga-young","family":"Lim","sequence":"additional","affiliation":[{"name":"Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine, Seoul, South Korea"},{"name":"Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiin","family":"Ahn","sequence":"additional","affiliation":[{"name":"Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seungho","family":"Ryu","sequence":"additional","affiliation":[{"name":"Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine, Seoul, South Korea"},{"name":"Department of Occupational and Environmental 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