Key result
SGLT2 inhibitors were associated with a lower rate of heart failure hospitalization or all-cause mortality compared to DPP-4 inhibitors (HR 0.49; 95% CI 0.45-0.54).
Why the study?
To analyse the rate of heart failure hospitalization for older adults prescribed an SGLT2 inhibitor.
Do SGLT2 inhibitors reduce the composite of heart failure hospitalization and all-cause mortality in older adults with diabetes mellitus compared to DPP-4 inhibitors?
Cohort (n=59,832)
Do SGLT2 inhibitors reduce the composite of heart failure hospitalization and all-cause mortality in older adults with diabetes mellitus compared to DPP-4 inhibitors?
Hazard Ratio: 0.49 (95% CI 0.45–0.54)
Absolute Event Rate: 19% vs 38%
In older adults with diabetes mellitus, SGLT2 inhibitors were associated with a 51% relative risk reduction in heart failure hospitalization or all-cause mortality compared to DPP-4 inhibitors.
May support SGLT2 inhibitor preference in diabetes; leaves open causal confirmation by RCTs.
AIMS: To analyse the rate of heart failure hospitalization for older adults prescribed a sodium-glucose co-transporter-2 (SGLT2) inhibitor. MATERIALS AND METHODS: The study cohort included adults aged 66 years and older diagnosed with diabetes mellitus in Ontario, Canada, between July 2015 and March 2019, who received either an SGLT2 inhibitor or a dipeptidyl peptidase-4 (DPP-4) inhibitor. The primary outcome was a composite of heart failure hospitalization and all-cause mortality. Secondary outcomes included diabetic ketoacidosis and hypoglycaemia. RESULTS: A total of 29 916 adults prescribed an SGLT2 inhibitor were compared with 29 916 adults prescribed a DPP-4 inhibitor. The mean age was 72 years, 60% were men, the baseline glycated haemoglobin concentration was 8.2% and the baseline creatinine was 89 μmol/L. The incidence rate of the primary outcome was 19/1000 person-years for adults prescribed an SGLT2 inhibitor compared to 38/1000 person-years in those prescribed a DPP-4 inhibitor. This resulted in a hazard ratio (HR) of 0.49 (95% confidence interval [CI] 0.45, 0.54) and a rate difference (RD) of 19 fewer events per 1000 person-years (RD -19 [95% CI -22, -17]). Patients prescribed an SGLT2 inhibitor also had a lower rate of hypoglycaemia (HR 0.61 [95% CI 0.46, 0.81); RD -1.6 [95% CI -2.4, -0.8]), but a higher rate of diabetic ketoacidosis (HR 1.84 [95% CI 1.26, 2.70]; RD 1.0 [95% CI 0.4, 1.6]). CONCLUSIONS: Older adults prescribed an SGLT2 inhibitor had a lower rate of heart failure hospitalization or death, and a lower rate of hypoglycaemia, but an increased rate of diabetic ketoacidosis compared to older adults prescribed a DPP-4 inhibitor.
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Fralick et al. (2020) conducted a cohort in Diabetes mellitus (n=59,832). Sodium-glucose co-transporter-2 (SGLT2) inhibitor vs. Dipeptidyl peptidase-4 (DPP-4) inhibitor was evaluated on Composite of heart failure hospitalization and all-cause mortality (HR 0.49, 95% CI 0.45-0.54). SGLT2 inhibitors were associated with a lower rate of heart failure hospitalization or all-cause mortality compared to DPP-4 inhibitors (HR 0.49; 95% CI 0.45-0.54).
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