• Drug: Liraglutide
  Liraglutide dispensing claim is used as the exposure group
• Drug: DPP-4 inhibitor
  DPP-4 inhibitor dispensing claim is used as the reference group

• DPP-4 inhibitor
  Reference group
  Intervention: Drug: DPP-4 inhibitor
• Liraglutide
  Exposure group
  Intervention: Drug: Liraglutide

Please see: https://drive.google.com/drive/folders/1WD618wrywYjEaXzfLTcuK-VCcnb6b-gV for full code and algorithm definitions.

Eligible cohort entry dates Market availability of liraglutide in the U.S. started on January 20, 2010. For Marketscan and Medicare: January 20, 2010-Dec 31, 2016 (end of data availability).

For Optum: January 20, 2010-Sep 30, 2017 (end of data availability).

Inclusion Criteria:

• Men or women with type 2 diabetes

• Either of the following:

  • Prior cardiovascular disease cohort: Age ≥ 50 years at screening, AND at least one of the following:

    • Prior MI
    • Prior stroke or TIA
    • Prior coronary, carotid or peripheral arterial revascularization
  • >50% stenosis of coronary, carotid, or lower extremity arteries coded by Peripheral vascular disease
  • Chronic heart failure NYHA class II-III
  • CKD stage 3-6 as Chronic renal failure:

• No Prior cardiovascular disease group: Age ≥ 60 years at screening, AND at least one of the following:

  • Microalbuminuria or proteinuria
  • Hypertension and left ventricular hypertrophy by ECG or imaging
  • Ankle-brachial index <0.9

Exclusion Criteria:

• Type 1 diabetes
• Use of a GLP-1 receptor agonist (exenatide, liraglutide or other) or pramlintide or any (dipeptidyl peptidase 4 (DPP-4) inhibitor within the 3 months prior to screening
• Use of long-term insulin in 90 days prior
• Diabetic ketoacidosis in 3 months prior to index date as Acute decompensation of glycaemic control requiring immediate intensification of treatment to prevent acute complications of diabetes (e.g., diabetic ketoacidosis) in the previous 3 months
• Inpatient (hospitalization) code for MI, stroke, revascularization, PTCA, CABG IN PRIOR 14 DAYS as An acute coronary or cerebrovascular event in the previous 14 days
• inpatient Heart failure (CHF) as Chronic heart failure NYHA class IV
• ESRD codes as Current continuous renal replacement therapy
• Liver disease as "End stage liver disease, defined as the presence of acute or chronic liver disease and recent history of one or more of the following: ascites, encephalopathy, variceal bleeding, bilirubin ≥ 2.0 mg/dL, albumin level ≤ 3.5 g/dL, prothrombin time ≥ 4 seconds prolonged, international normalised ratio (INR) ≥1.7 or prior liver transplant"
• Organ transplant codes as A prior solid organ transplant or awaiting solid organ transplant
• History of malignant neoplasm in previous 5 years 140.xx-208.xx (except 173.xx, non-melanoma skin cancer)
• Family or personal history of multiple endocrine neoplasia type 2 (MEN2) or familial medullary thyroid carcinoma (FMTC)
• Personal history of non-familial medullary thyroid carcinoma
• Drug abuse or dependence as Known use of non prescribed narcotics or illicit drugs
• Encounter for contraceptive management, Oral contraceptives, and pregnancy as "Females of childbearing potential who are pregnant, breast-feeding or intend to become pregnant or are not using adequate contraceptive methods (adequate contraceptive measures as required by local law or practice)"