Is there a potential association between spironolactone and the risk of new-onset diabetes in a cohort of older patients with heart failure?

PurposeSome evidence suggests that spironolactone may have a deleterious effect on glucose homeostasis. The objective of this study was to assess whether spironolactone use is associated with a higher risk of developing diabetes in a large cohort of patients with heart failure (HF).MethodsTwo Quebec government administrative databases were used to identify a cohort of hospitalized patients discharged between January 1995 and December 2009 with a primary discharge diagnosis of HF and without secondary discharge diagnosis of diabetes. Patients were categorized as new users of spironolactone and non-users. The primary outcome was defined as new-onset diabetes (NOD) during 5years of follow-up and was ascertained using ICD codes for diabetes or use of hypoglycemic agents.ResultsAmong the 2974 patients that were included in the cohort analysis, 769 were given a new prescription of spironolactone. The incidence rate of NOD was similar among spironolactone users (5.0 per 100 person-years) and non-users (4.9 per 100 person-years). There was no significant association between the use of spironolactone and NOD in the crude, unadjusted model (hazard ratio (HR) 1.01; 95% confidence interval (CI) 0.80-1.28; p=0.9217), and it remained unchanged in the adjusted Cox proportional hazard model (HR=0.92; 95% CI=0.72-1.18; p=0.5227). The results were consistent with those observed in sensitivity analyses of a 1:3 propensity score-matched cohort (HR=0.97; CI=0.76-1.25; p=0.8169).ConclusionWe found no evidence supporting the claim that use of spironolactone is associated with a higher risk of diabetes among patients hospitalized for HF.