Key result
SGLT2i use was associated with a lower risk of cardiorenal disease compared to DPP4i in patients with type 2 diabetes free of cardiovascular and renal disease (HR 0.56; 95% CI 0.42-0.74).
Why the study?
The study aimed to compare the risk of cardiorenal disease, heart failure, or chronic kidney disease between new users of SGLT2 inhibitors and DPP4 inhibitors among patients with type 2 diabetes free of prevalent cardiovascular and renal disease.
Does new use of SGLT2i reduce the risk of cardiorenal disease, HF, or CKD compared to DPP4i in patients with type 2 diabetes without prevalent cardiovascular and renal disease?
Cohort (n=210,260)
Yes
Does new use of SGLT2i reduce the risk of cardiorenal disease, HF, or CKD compared to DPP4i in patients with type 2 diabetes without prevalent cardiovascular and renal disease?
Hazard Ratio: 0.56 (95% CI 0.42–0.74)
In patients with type 2 diabetes without established cardiovascular or renal disease, SGLT2 inhibitors are associated with a significantly lower risk of incident heart failure, chronic kidney disease, and mortality compared to DPP4 inhibitors.
SGLT2i may lower cardiorenal risk versus DPP4i in CVRD-free T2D; leaves open confirmation in randomized trials.
AIMS: We compared the new use of sodium-glucose cotransporter-2 inhibitor (SGLT2i) versus dipeptidyl peptidase-4 inhibitor (DPP4i) and the risk of cardiorenal disease, heart failure (HF) or chronic kidney disease (CKD), in patients with type 2 diabetes without a history of prevalent cardiovascular and renal disease, defined as cardiovascular and renal disease (CVRD) free, managed in routine clinical practice. MATERIALS AND METHODS: In this observational cohort study, patients were identified from electronic health records from England, Germany, Japan, Norway, South Korea and Sweden, during 2012-2018. In total, 1 006 577 CVRD-free new users of SGLT2i or DPP4i were propensity score matched 1:1. Unadjusted Cox regression was used to estimate hazard ratios (HRs) for outcomes: cardiorenal disease, HF, CKD, stroke, myocardial infarction (MI), cardiovascular and all-cause mortality. RESULTS: Baseline characteristics were well balanced between the treatment groups (n = 105 130 in each group) with total follow-up of 187 955 patient years. Patients had a mean age of 56 years, 43% were women and they were indexed between 2013 and 2018. The most commonly used agents were dapagliflozin (91.7% of exposure time) and sitagliptin/linagliptin (55.0%), in the SGLT2i and DPP4i, groups, respectively. SGLT2i was associated with lower risk of cardiorenal disease, HF, CKD, all-cause and cardiovascular mortality; HR (95% confidence interval), 0.56 (0.42-0.74), 0.71 (0.59-0.86), 0.44 (0.28-0.69), 0.67 (0.59-0.77), and 0.61 (0.44-0.85), respectively. No differences were observed for stroke [0.87 (0.69-1.09)] and MI [0.94 (0.80-1.11)]. CONCLUSION: In this multinational observational study, SGLT2i was associated with a lower risk of HF and CKD versus DPP4i in patients with type 2 diabetes otherwise free from both cardiovascular and renal disease.
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Birkeland et al. (2020) conducted a cohort in Type 2 diabetes without cardiovascular and renal diseases (n=210,260). Sodium-glucose cotransporter-2 inhibitor (SGLT2i) vs. Dipeptidyl peptidase-4 inhibitor (DPP4i) was evaluated on Cardiorenal disease (HR 0.56, 95% CI 0.42-0.74). SGLT2i use was associated with a lower risk of cardiorenal disease compared to DPP4i in patients with type 2 diabetes free of cardiovascular and renal disease (HR 0.56; 95% CI 0.42-0.74).
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