Early Initiation of Antidiabetic Medication After Diabetes Diagnosis tied With Lower Mortality Risk: JAMA

A new study published in the Journal of American Medical Association showed that early commencement of antidiabetic medicine (ADM) to achieve glycemic control was linked to a gradually decreasing risk of death among people who met the diagnostic criterion for type 2 diabetes mellitus.

Individuals who reach the diagnostic criteria for type 2 diabetes (T2D) should begin using antidiabetic medicine as soon as possible to reduce long-term cardiovascular risk. Thus, this study determined the relationship between ADM beginning timing (within 3, 6, or 12 months) and the risk of major adverse cardiovascular events (MACE) and all-cause mortality among people who had recently met diagnostic criteria for type 2 diabetes.

In this cohort research, health screening data associated with health insurance claims in Korea (2013-2022) were analyzed utilizing a clone-censor-weight strategy using target trial emulation. Adults with newly identified glycated hemoglobin (HbA1c) of 6.5% or higher or fasting plasma glucose of 126 mg/dL or higher were the participants. The period of data analysis was January through August of 2025.

ADM initiation within 3, 6, or 12 months or no initiation within 12 months (strategies 1, 2, 3, and control, respectively) were the 4 treatment options into which eligible patients were allocated. Kaplan-Meier survival probabilities and 95% CIs using 1000-sample nonparametric bootstrapping were used to assess the 5-year absolute risk difference (RD) and risk ratio (RR) of 3-point MACE (myocardial infarction, stroke, and all-cause death) and all-cause mortality.

4 treatment options were applied to a total of 23,452 eligible patients. Although it did not reach statistical significance, earlier ADM initiation showed gradually lower point estimates for 3-point MACE when compared to the control (RR, 0.32; 95% CI, 0.15 to 1.11 for strategy 1; RR, 0.65; 95% CI, 0.41 to 1.29 for strategy 2; RR, 0.93; 95% CI, 0.70 to 1.41 for strategy 3).

The corresponding RDs were, respectively, −0.97% (95% CI, −1.26% to 0.14%), −0.49% (−0.84% to 0.40%), and −0.10% (−0.44% to 0.57%). In both relative (RR, 0.31; 95% CI, 0.10-0.98) and absolute (RD, −0.40%; 95% CI, −0.57% to −0.01%) scales, starting ADM within three months significantly reduced the risk of all-cause death when compared to the control. Overall, among people who exceeded the diagnostic criterion for T2D, earlier commencement of ADM to treat hyperglycemia was associated with a gradually decreased risk of death, corroborating the legacy effect found in previous research.

Source:

Ko, H. Y., Shin, J.-Y., Jung, K., Bea, S., Hong, B., Noh, Y., Bae, J. H., Kwak, S. H., Cho, Y. M., Lim, G.-Y., Ahn, J., Ryu, S., Kim, J. H., & Chang, Y. (2026). Timing of antidiabetic medication initiation and risk of cardiovascular events and mortality. JAMA Network Open, 9(6), e2619362. https://doi.org/10.1001/jamanetworkopen.2026.19362