Comparative Effectiveness of Diabetes Drugs: The Use and Misuse of Observational Research

EditorialsJune 2023Comparative Effectiveness of Diabetes Drugs: The Use and Misuse of Observational ResearchSteven E. Nissen, MDSteven E. Nissen, MDC5Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OhioSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-0958 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail With the global expansion of patients with diabetes, the comparative effectiveness of alternative pharmacotherapies for treatment is important and timely. In their article, Richardson and colleagues (1) report 2 different analyses that compare major adverse cardiovascular events (MACE) and heart failure (HF) hospitalizations for glucagon-like peptide-1 receptor agonists (GLP1RA) or sodium–glucose cotransporter-2 inhibitors (SGLT2i) compared with dipeptidyl peptidase-4 inhibitors (DPP4i) (a reasonable surrogate for placebo) in a primary prevention population of Veterans Health Administration (VHA) patients. They conclude that use of GLP1RA is associated with reductions in MACE (adjusted hazard ratio [HR], 0.82 [95% CI, 0.72 to 0.94]), whereas SGLT2i ...References1. Richardson TL, Halvorson AE, Hackstadt AJ, et al. Primary occurrence of cardiovascular events after adding sodium–glucose cotransporter-2 inhibitors or glucagon-like peptide-1 receptor agonists compared to dipeptidyl peptidase-4 inhibitors. A cohort study in veterans with diabetes. Ann Intern Med. 2023;176:751-760. doi:10.7326/M22-2751 LinkGoogle Scholar2. Gerstein HC, Colhoun HM, Dagenais GR, et al; REWIND Investigators. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet. 2019;394:121-130. [PMID: 31189511] doi:10.1016/S0140-6736(19)31149-3 CrossrefMedlineGoogle Scholar3. Marso SP, Daniels GH, Brown-Frandsen K, et al; LEADER Steering Committee. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375:311-22. [PMID: 27295427] doi:10.1056/NEJMoa1603827 CrossrefMedlineGoogle Scholar4. Neal B, Perkovic V, Mahaffey KW, et al; CANVAS Program Collaborative Group. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377:644-657. [PMID: 28605608] doi:10.1056/NEJMoa1611925 CrossrefMedlineGoogle Scholar5. Zinman B, Wanner C, Lachin JM, et al; EMPA-REG OUTCOME Investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373:2117-28. [PMID: 26378978] doi:10.1056/NEJMoa1504720 CrossrefMedlineGoogle Scholar6. Wiviott SD, Raz I, Bonaca MP, et al; DECLARE–TIMI 58 Investigators. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019;380:347-357. [PMID: 30415602] doi:10.1056/NEJMoa1812389 CrossrefMedlineGoogle Scholar7. National Research Council (US) Panel on Handling Missing Data in Clinical Trials. The Prevention and Treatment of Missing Data in Clinical Trials. National Academies Pr; 2010. Google Scholar8. Webster PC. Sweden's health data goldmine. CMAJ. 2014;186:E310. [PMID: 24821866] doi:10.1503/cmaj.109-4713 CrossrefMedlineGoogle Scholar9. Holman RR, Bethel MA, Mentz RJ, et al; EXSCEL Study Group. Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2017;377:1228-1239. [PMID: 28910237] doi:10.1056/NEJMoa1612917 CrossrefMedlineGoogle Scholar10. Aminian A, Zajichek A, Arterburn DE, et al. Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity. JAMA. 2019;322:1271-1282. [PMID: 31475297] doi:10.1001/jama.2019.14231 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Steven E. Nissen, MDAffiliations: C5Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OhioDisclosures: The author has reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-0958.Corresponding Author: Steven E. Nissen, MD, C5Research, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; e-mail, [email protected]org.This article was published at Annals.org on 9 May 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPrimary Occurrence of Cardiovascular Events After Adding Sodium–Glucose Cotransporter-2 Inhibitors or Glucagon-like Peptide-1 Receptor Agonists Compared With Dipeptidyl Peptidase-4 Inhibitors: A Cohort Study in Veterans With Diabetes Tadarro L. Richardson Jr. , Alese E. Halvorson , Amber J. Hackstadt , Adriana M. Hung , Robert Greevy , Carlos G. Grijalva , Tom A. Elasy , and Christianne L. Roumie Metrics Current IssueJune 2023Volume 176, Issue 6Page: 864-865KeywordsDiabetes medicationsDrug therapyHeart failureMyocardial infarctionObservational studies ePublished: 9 May 2023 Issue Published: June 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...