{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T04:22:10Z","timestamp":1790050930545,"version":"4.0.1"},"reference-count":40,"publisher":"American Diabetes Association","issue":"11","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"vor","delay-in-days":2878,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2013,11,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>To assess the association of hypoglycemic treatment regimens with cardiovascular adverse events and mortality in a large population of type 2 diabetic patients at increased cardiovascular risk.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>This analysis included 8,192 overweight patients with type 2 diabetes from the Sibutramine Cardiovascular Outcomes (SCOUT) trial randomized to lifestyle intervention with or without sibutramine for up to 6 years. Patients were grouped according to hypoglycemic treatment at baseline. The primary end point was the time from randomization to the first occurrence of a primary outcome event (POE), nonfatal myocardial infarction, nonfatal stroke, resuscitation after cardiac arrest, or cardiovascular death. Multivariable Cox proportional hazards regression models were used to assess the impact of antiglycemic treatment on POE and all-cause mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Treatments for type 2 diabetes were as follows: diet alone (n = 1,394 subjects), metformin monotherapy (n = 1,631), insulin monotherapy (n = 1,116), sulfonylurea monotherapy (n = 1,083), metformin plus sulfonylurea (n = 1,565), and metformin plus insulin (n = 1,000); 905 subjects experienced a POE and 708 died. Metformin monotherapy was associated with lower risk of POE than insulin (hazard ratio [HR], 0.74; 95% CI, 0.57\u20130.95; P = 0.02). Diet alone also was associated with lower risk of POE (HR, 0.65; 95% CI, 0.48\u20130.87; P = 0.004). Metformin monotherapy also was associated with lower mortality (HR, 0.73; 95% CI, 0.54\u20130.99; P &amp;lt; 0.05), whereas no other monotherapies or combination therapies were significantly associated with POE or all-cause mortality compared with insulin as monotherapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>In obese patients with type 2 diabetes and high risk of cardiovascular disease, monotherapy with metformin or diet-only treatment was associated with lower risk of cardiovascular events than treatment with insulin.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc13-0027","type":"journal-article","created":{"date-parts":[[2013,10,3]],"date-time":"2013-10-03T01:16:46Z","timestamp":1380763006000},"page":"3746-3753","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":25,"title":["Association of Hypoglycemic Treatment Regimens With Cardiovascular Outcomes in Overweight and Obese Subjects With Type 2 Diabetes"],"prefix":"10.2337","volume":"36","author":[{"given":"Adam Ali","family":"Ghotbi","sequence":"first","affiliation":[{"name":"Department of Clinical Physiology, Nuclear Medicine, Positron Emission Tomography, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark"},{"name":"The Heart Center, Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"K\u00f8ber","sequence":"additional","affiliation":[{"name":"The Heart Center, Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Finer","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Science, University College London, London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Philip T.","family":"James","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arya M.","family":"Sharma","sequence":"additional","affiliation":[{"name":"Royal Alexandra Hospital, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Caterson","sequence":"additional","affiliation":[{"name":"The Boden Institute, University of Sydney, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walmir","family":"Coutinho","sequence":"additional","affiliation":[{"name":"Endocrinology, Obesity, and Eating Disorders Research Group, Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc F.","family":"Van Gaal","sequence":"additional","affiliation":[{"name":"Department of Diabetology, Metabolism, and Clinical Nutrition, Antwerp University Hospital, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Torp-Pedersen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Andersson","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2013,10,15]]},"reference":[{"key":"2022031302051927600_B1","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1007\/s11936-010-0080-y","article-title":"Therapeutic approaches to obesity","volume":"12","author":"Powell","year":"2010","journal-title":"Curr Treat Options Cardiovasc Med"},{"key":"2022031302051927600_B2","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1038\/nrendo.2011.232","article-title":"Nonpharmacological interventions for the prevention of type 2 diabetes mellitus","volume":"8","author":"Schwarz","year":"2012","journal-title":"Nat Rev Endocrinol"},{"key":"2022031302051927600_B3","doi-asserted-by":"crossref","first-page":"2952","DOI":"10.1161\/01.CIR.0000145546.97738.1E","article-title":"Clinical implications of obesity with specific focus on CVD: a statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation","volume":"110","author":"Klein","year":"2004","journal-title":"Circulation"},{"key":"2022031302051927600_B4","doi-asserted-by":"crossref","first-page":"39S","DOI":"10.1016\/j.amjmed.2003.10.019","article-title":"Preventing cardiovascular events in patients with diabetes mellitus","volume":"116","author":"Abraham","year":"2004","journal-title":"Am J Med"},{"key":"2022031302051927600_B5","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/1475-2840-9-54","article-title":"Effects of oral glucose-lowering drugs on long term outcomes in patients with diabetes mellitus following myocardial infarction not treated with emergent percutaneous coronary intervention\u2014a retrospective nationwide cohort study","volume":"9","author":"J\u00f8rgensen","year":"2010","journal-title":"Cardiovasc Diabetol"},{"key":"2022031302051927600_B6","doi-asserted-by":"crossref","first-page":"2546","DOI":"10.1007\/s00125-010-1906-6","article-title":"Metformin treatment is associated with a low risk of mortality in diabetic patients with heart failure: a retrospective nationwide cohort study","volume":"53","author":"Andersson","year":"2010","journal-title":"Diabetologia"},{"key":"2022031302051927600_B7","doi-asserted-by":"crossref","first-page":"386","DOI":"10.7326\/0003-4819-147-6-200709180-00178","article-title":"Systematic review: comparative effectiveness and safety of oral medications for type 2 diabetes mellitus","volume":"147","author":"Bolen","year":"2007","journal-title":"Ann Intern Med"},{"key":"2022031302051927600_B8","doi-asserted-by":"crossref","first-page":"2070","DOI":"10.1001\/archinte.168.19.2070","article-title":"Cardiovascular outcomes in trials of oral diabetes medications: a systematic review","volume":"168","author":"Selvin","year":"2008","journal-title":"Arch Intern Med"},{"key":"2022031302051927600_B9","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s11892-009-0015-8","article-title":"Potential of glucose-lowering drugs to reduce cardiovascular events","volume":"9","author":"Zarich","year":"2009","journal-title":"Curr Diab Rep"},{"key":"2022031302051927600_B10","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s11886-011-0238-6","article-title":"Does aggressive glycemic control benefit macrovascular and microvascular disease in type 2 diabetes? 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