Safety issues associated with blood glucose lowering drugs are not new, the safety of these treatments has been questioned and highly publicized. It has been reported that some of them increase the risk or modify the prognosis of cancer, cardiovascular (CVD) or pancreatic diseases.The primary objective of the comparative studies in SAFEGUARD is to estimate the risk of myocardial infarction (MI), heart failure (HF), ventricular arrhythmia (VA)/sudden cardiac death (SCD), ischemic stroke (IS), hemorrhagic stroke (HS), acute pancreatitis (AP), pancreatic cancer (PC), bladder cancer (BC) and total mortality (TM) associated with the use of non-insulin blood glucose lowering drugs (NIBGLD), insulins and insulin analogs in subjects with T2DM.Data collected in 9 different electronic health databases from 5 different European countries the USA will be used. Nested case control studies in a cohort of T2DM patients will be conducted to assess the association of NIBGLD, insulins, and insulin analogs with MI, HF, VA/SCD, IS, HS, AP, BC and PC and a dynamic retrospective cohort study to estimate the association with TM.For the estimation of the risk, in the case control studies, cases will be compared with matched controls and adjusted for potential confounders. Conditional logistic regression will be used to calculate the unadjusted and adjusted odds ratios (ORs) with their 95% confidence intervals (CIs) with reference to another active compound.For the cohort studies, hazard ratios and incidence rates (IR) and the relative risk for TM with their 95% CIs will be estimated using Cox-regression. Time varying analyses will be conducted for estimation of the effect of duration of treatment. All analyses will be performed for each database separately and the heterogeneity among databases will be examined (e.g., I2). Advanced methodologies, subanalyses and sensitivity analyses will be carried out to deal with methodological issues.(i.e propensity scores, etc).
