Use of anti-diabetic medications and fatal traffic crashes: A case-based analysis

초록

Background: There are few studies focused on oral hypoglycemic agents and risk of motor vehicle accidents and no data on newly approved glycemic treatment agents for the risk of road traffic accidents. Objectives: We evaluate whether the use of anti-diabetic medications and the risk of road traffic death in a case-based analysis. Methods: We used a Korean national road traffic authority database linked with a national health insurance database between January 1, 2010 and December 31, 2014 and applied a case-crossover design. The study subjects were drivers in South Korea who died from traffic accidents and who had prescriptions for anti-diabetic medications within 1 year prior to the date of the accident. We compared the status of prescription for anti-diabetic medications with the hazard period and four matched control periods using conditional logistic regression, adjusting for other drug use. When anti-diabetic medication shows an obvious increase in the exposure trend, the case-case-time-control design was applied to adjust the effect of the exposure trend on the risk estimate. Results: A total of 1032 anti-diabetics-using drivers were included. In the case-crossover analysis, the odds ratio of total anti-diabetics was 3.61 (95% CI: 2.68-4.88) adjusting for the use of narcotics, muscle relaxants, antipsychotics, antihistamines, antispasmodics, antiemetics, and hypnotics. In the case-crossover analysis by the class of anti-diabetics, insulin (aOR: 5.81, 95% CI: 4.36-7.75) and a fixed-dose combination of metformin and a dipeptidyl peptidase-4 (DPP-4) inhibitor (aOR: 2.51, 95%CI: 2.68-4.88) showed significantly increased risk of accident. The risk between the fatal crash and total anti-diabetics (1.07, 0.95-1.22), DPPi+MET (1.02, 0.67-1.55) was negligible and statistically insignificant in the case-case-time-control analysis to adjust effect of the utilization trend. Conclusions: There was no increased risk of fatal traffic accidents with the use of newly approved glycemic treatment agents after considering the trends of anti-diabetic medication prescription and utilization.