Sodium glucose co‐transporter 2 inhibitors versus dipeptidyl peptidase‐4 inhibitors and the risk of ventricular arrhythmia among patients with type 2 diabetes: A population‐based cohort study

Aims To determine whether sodium glucose co‐transporter 2 inhibitors (SGLT2i) use, compared with dipeptidyl peptidase‐4 inhibitors (DPP4i) use, is associated with the risk of ventricular arrhythmias (VA) among patients with type 2 diabetes. Materials and Methods We conducted a population‐based cohort study using a prevalent new‐user design and data from the United Kingdom Clinical Practice Research Datalink Aurum, linked to hospitalisation and vital statistics data. SGLT2i users were matched to DPP4i users on diabetes treatment intensity, duration of prior DPP4i use, calendar time, sex, age, and time‐conditional propensity score. Cox models estimated the hazard ratio (HR) and corresponding 95% confidence intervals (CI) for VA with SGLT2i vs. DPP4i use. Secondary analyses stratified by SGLT2i user type. Secondary outcomes included fatal VA and cardiac arrest. Results Among 88 516 matched patients, 385 VA events occurred over a mean follow‐up of 0.86 years (25.3 per 10 000 person‐years). Overall, SGLT2i use was not associated with the risk of VA (HR: 0.88, 95% CI: 0.71–1.07). There was no association among incident new users (HR: 0.98, 95% CI: 0.76–1.27) but SGLT2i use was associated with a lower risk among prevalent new users (HR: 0.65, 95% CI: 0.46–0.92). SGLT2i use was associated with a lower risk of cardiac arrest (HR: 0.64, 95% CI: 0.49–0.83); our analysis of fatal VA was inconclusive due to sparse data (HR: 1.76, 95% CI: 0.47–6.64). Conclusions SGLT2i use was not associated with the risk of VA among patients with type 2 diabetes.