Timing of Antidiabetic Medication Initiation and Risk of Cardiovascular Events and Mortality
Authors' conclusion
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.
Study context
- Population
- Adults with newly detected HbA1c ≥6.5% or FPG ≥126 mg/dL, Korea (2013–2022); mean age 48.2 years, 24.7% femalecloned into 4 strategies
- Participants
- 23,452 adults
- Exposure
- Antidiabetic medication (ADM) initiation within 3, 6 or 12 months vs no initiation within 12 months
- Outcome
- 3-point major adverse cardiovascular events (MACE) (stroke, MI, all-cause mortality) and all-cause mortality: absolute risk difference (RD) and RR
- Follow-up
- 5 years
Methodological detailsclone-censor-weight approach, health screening data linked to health insurance claims
- Clone-censor-weight approach
- Health screening data linked to health insurance claims
Main finding
As reported in the abstract
3-point MACE
Each group vs controlRelative risk (95% CI)
Strategy 1
0.32(0.15–1.11)
Strategy 2
0.65(0.41–1.29)
Strategy 3
0.93(0.70–1.41)
Each group vs controlRD (95% CI)
Strategy 1
−0.97%(−1.26% to 0.14%)
Strategy 2
−0.49%(−0.84% to 0.40%)
Strategy 3
−0.10%(−0.44% to 0.57%)
Observational data: associations, not effects.
Further findings
| Outcome | RR (95% CI) | |
|---|---|---|
| All-cause mortality · 5 yearsStrategy 1vs Control | 0.31 (0.10–0.98) | |
| 0.10.31310Relative risk (log scale) |
| Outcome | RD (95% CI) | |
|---|---|---|
| All-cause mortality · 5 yearsStrategy 1vs Control | −0.40% (−0.57% to −0.01%) | |
| −1−0.500.5Difference (linear scale) |
Original publication
Timing of Antidiabetic Medication Initiation and Risk of Cardiovascular Events and Mortality. JAMA Netw Open. Published 1 June 2026. doi:10.
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