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?:abstract
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AIMS To date, the association between different oral anticoagulants and the risk of developing diabetes mellitus (DM) is unknown. Our study aimed to compare the risk of DM development in patients with atrial fibrillation (AF) treated with non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin. MATERIALS AND METHODS We conducted a nationwide retrospective cohort study using Taiwan\'s National Health Insurance Research Database. Adult patients with a new onset of AF, treated with NOACs or warfarin between 2012 and 2016, were included. The NOAC cohort was further divided into dabigatran, rivaroxaban, and apixaban groups. The primary outcome was incident DM requiring treatment with anti-diabetic drugs. Fine and Gray subdistribution hazards models were used to estimate the adjusted hazard ratio (HR). Propensity score matching was performed for each head-to-head comparison. RESULTS A total of 10 746 new-onset AF patients were included in our study. During the mean 2.4-year follow-up, NOACs were associated with a lower risk of developing DM than warfarin (HR = 0.80, 95% confidence interval [CI]: 0.68-0.94, p = 0.007). Subgroup analyses confirmed that dabigatran, rivaroxaban, and apixaban each had a reduced DM risk. Stratified analyses demonstrated that the lower risk of DM associated with NOAC treatment was specific to elderly patients, ≥65 years old (HR = 0.74, 95% CI: 0.62-0.89, p = 0.002) and those with good medication adherence (HR = 0.70, 95% CI: 0.58-0.84, p < 0.001). CONCLUSIONS Taking NOAC was associated with a lower risk of developing DM than taking warfarin in patients with AF. This article is protected by copyright. All rights reserved.
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