Sodium-glucose cotransporter 2 inhibitor (SGLT2i) use is associated with a significantly reduced risk of pneumonia and pneumonia mortality compared with dipeptidyl peptidase-4 inhibitor (DPP4i) use in people with type 2 diabetes (T2D). The study was published in the Journal of Clinical Endocrinology and Metabolism.
Researchers used the Clinical Data Analysis and Reporting System (CDARS) medical database in Hong Kong, China, to evaluate the association between SGLT2i and DPP4i use and the risk of pneumonia.
Eligible participants were patients with type 2 diabetes with prescription records of SGLT2i or DPP4i use from 2015 to 2018.
A total of 9895 patients who initiated use of SGLT2is and 93,481 patients who initiated or continued with DPP4is were identified in the database. The final 1:4 propensity score (PS)-matched cohort included 6664 patients in the SGLT2i group and 26,656 patients in the DPP4i group.
Participants were followed for a median of 3.8 (interquartile range [IQR],1.5) years in the SGLT2i group and 3.7 (IQR, 1.6) years in the DPP4i group. In the regression analyses, use of SGLT2is was associated with a significantly reduced risk of pneumonia vs use of DPP4is (absolute rate difference, 4.05 per 1000 person-years; 95% CI, 2.61-5.51; incidence rate ratio, 0.71; 95% CI, 0.62-0.81; P < .001) after further adjustment for concurrent use of sulfonylureas, thiazolidinediones, and insulin. No significant interaction was found with sex (P = .840).
Competing risk regression showed that use of SGLT2is was associated with a significantly reduced risk of pneumonia death compared with use of DPP4is (hazard ratio, 0.57; 95% CI, 0.42-0.77; P < .001), after adjustment for concurrent use of sulfonylureas, thiazolidinediones, and insulin. There was no significant interaction with gender (P = .540).
Among several study limitations, the database did not include lifestyle data, and patients’ compliance to their prescription therapy was unknown. In addition, there was potential for by-indication bias, and the algorithm used may not have been able to distinguish all type 1 diabetes (T1D) patients from T2D patients.
“With a deeper understanding of the role of SGLT2is in respiratory infections, a better prognosis of diabetic patients could be achieved,” stated the researchers.
Au PCM, Tan KCB, Cheung BMY, et al. Association between SGLT2 inhibitors vs DPP-4 inhibitors and risk of pneumonia among patients with type 2 diabetes. J Clin Endocrinol Metab. Published online November 8, 2021. doi:10.1210/clinem/dgab818