Treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitors was found to be associated with decreased risk of all-cause mortality and hospitalization in patients with type 2 diabetes (T2D), according to the results of a retrospective cohort study published in Diabetes, Obesity and Metabolism.
Data from the Clinical Practice Research Datalink Aurum, which contains information from more than 19 million patients in the United Kingdom, were analyzed for this study. Patients with T2D undergoing treatment with SGLT2 inhibitors or dipeptidyl peptidase-4 (DPP-4) inhibitors were propensity matched and assessed for differences in clinical outcomes. Most of the 131,824 patients with T2D (58.3%) had no known history of cardiovascular or renal disease (CVRD), and 60.8% had a documented history of cardiovascular disease.
After propensity matching, 24,438 new users of SGLT2 inhibitors and DPP-4 inhibitors were assessed. The mean age of participants was 56.7 years and 56.1 years, 42.6% and 42.4% were women, and 22.0% and 22.2% were frail in the SGLT2 inhibitor and DPP-4 inhibitor groups, respectively. A subset of 17,353 patients in both groups had no history of CVRD, and 11,367 were at high risk for cardiorenal disease.
Compared with DPP-4 inhibitors, SGLT2 inhibitors were associated with decreased risk of all-cause mortality (hazard ratio [HR], 0.73; 95% CI, 0.63-0.84; P <.001), cardiovascular death (HR, 0.80; 95% CI, 0.66-0.97; P =.022), hospitalization for heart failure (HR, 0.74; 95% CI, 0.65-0.84; P <.001), and hospitalization for chronic kidney disease (HR, 0.51; 95% CI, 0.47-0.56; P <.001) among all patients.
Among patients without a history of CVRD, SGLT2 inhibitors were associated with decreased risk of all-cause mortality (HR, 0.71; 95% CI, 0.57-0.88; P =.002), hospitalization for heart failure (HR, 0.76; 95% CI, 0.59-0.98; P =.035), and hospitalization for chronic kidney disease (HR, 0.75; 95% CI, 0.63-0.88; P <.001).
For the cohort at high risk for cardiorenal disease, SGLT2 inhibitors were associated with decreased risk of all-cause mortality (HR, 0.69; 95% CI, 0.59-0.82; P <.001); cardiovascular death (HR, 0.76; 95% CI, 0.62-0.95; P =.014); and hospitalization for heart failure (HR, 0.73; 95% CI, 0.63-0.85; P <.001), stroke (HR, 0.75; 95% CI, 0.59-0.94; P =.013), and chronic kidney disease (HR, 0.49; 95% CI, 0.43-0.54; P <.001).
Across any of the 3 cohorts, treatment with SGLT2 inhibitors was not associated with an altered risk of hospitalization for myocardial infarction. Altogether, SGLT2 inhibitor therapy was associated with a greater than 20% reduction in mortality and hospitalizations for heart failure or chronic kidney disease compared with treatment with DPP-4 inhibitors.
A limitation of this study was the inability to stratify patients who were using differing drugs within the same class. However, the study data indicated that among patients with T2D, regardless of their cardiorenal health, SGLT2 inhibitor treatment was superior to DPP-4 inhibitor treatment in reducing the risks of mortality and hospitalization.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original article for a full list of authors’ disclosures.
Idris I, Zhang R, Mamza J B, et al. Lower risk of hospitalisation for heart failure, kidney disease and death with sodium glucose co-transporter-2 compared to dipeptidyl peptidase-4 inhibitors in type 2 diabetes regardless of prior cardiovascular or kidney disease: a retrospective cohort study in UK primary care. Diabetes Obes Metab. Published online May 11, 2021. doi:10.1111/dom.14437