Pulmonary Hypertension
Antidiabetic Medications and Survival in PH Patients With Diabetes — VA Cohort
- Authors: VA Health System researchers
- Journal / date: Pulmonary Circulation, 2026
- DOI / URL: 10.1002/pul2.70313 | PMID 42088614 | PMC13136954
- Source basis: Full text (open access)
- Study type: Retrospective cohort (VHA data 2003-2015)
- PH group: Mixed (predominantly groups 2 and 3 in a VA population)
- Population: 41,670 veterans with PH + diabetes (median age 69, 97% male)
- Key findings (Cox-adjusted for demographics, comorbidities, renal function, HbA1c):
- Metformin: HR 0.83 (95% CI 0.80-0.86) for mortality — protective effect enhanced with lower eGFR but attenuated in lung disease
- Thiazolidinedione: HR 0.84 (0.79-0.89) — protective
- Insulin: HR > 1 for mortality (higher mortality)
- Mean survival from PH diagnosis: 3.5 years
- Why it matters (clinical takeaway):
- In PH patients with diabetes, choice of antidiabetic class may matter — observational data favor metformin (even down to lower eGFR thresholds within label) and TZD when otherwise appropriate.
- Insulin association with worse survival likely reflects severity / disease stage rather than direct harm, but reinforces aggressive use of metformin/TZD when safe before escalating to insulin.
- SGLT2 inhibitors and GLP-1 agonists were not assessed (cohort ended 2015) — newer evidence will likely supplant this once specific PH+T2D analyses emerge.
- Caveats / limitations: Retrospective, mostly male, pre-SGLT2i era. Confounding by indication (sicker patients get insulin).
- Referenced trials pulled forward: None.