Lower risk of hospitalization for heart failure, kidney disease and death with sodium‐glucose co‐transporter‐2 inhibitors compared with dipeptidyl peptidase‐4 inhibitors in type 2 diabetes regardless of prior cardiovascular or kidney disease: A retrospective cohort study in UK primary care

Iskandar Idris; Ruiqi Zhang; Jil Billy Mamza; Tamsin Morris; Amitava Banerjee; Kamlesh Khunti

doi:10.1111/dom.14437

May 11, 2021Diabetes Obesity and MetabolismOpen Access

Lower risk of hospitalization for heart failure, kidney disease and death with sodium‐glucose co‐transporter‐2 inhibitors compared with dipeptidyl peptidase‐4 inhibitors in type 2 diabetes regardless of prior cardiovascular or kidney disease: A retrospective cohort study in UK primary care

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Why the study?

To assess if SGLT2 inhibitors reduce all-cause mortality, CV death, and hospitalization for HF or CKD more than DPP4 inhibitors in T2D with or without established CVRD.

Do SGLT2 inhibitors reduce mortality and hospitalizations for heart failure or chronic kidney disease compared to DPP4 inhibitors in patients with type 2 diabetes?

Structured PICO

Do SGLT2 inhibitors reduce mortality and hospitalizations for heart failure or chronic kidney disease compared to DPP4 inhibitors in patients with type 2 diabetes?

P

Population

48,876 (24,438 propensity-matched pairs) patients with type 2 diabetes with or without established cardiovascular and/or renal disease in UK primary care.

I

Intervention

Sodium-glucose co-transporter-2 inhibitors (SGLT2is)

C

Comparator

Dipeptidyl peptidase-4 inhibitors (DPP4is)

O

Outcome

Time to each of the following: all-cause mortality, cardiovascular death, hospitalization for heart failure, myocardial infarction, stroke, and chronic kidney diseasehard clinical

SGLT2 inhibitors are associated with a lower risk of mortality, heart failure hospitalization, and CKD hospitalization compared to DPP4 inhibitors in patients with type 2 diabetes, regardless of prior cardiovascular or kidney disease.

Implication

SGLT2i initiation was associated with lower mortality and HF/CKD hospitalizations versus DPP4i in T2D; extends real-world data but leaves open need for randomized confirmation.

Abstract

AIM: To assess if sodium-glucose co-transporter-2 inhibitors (SGLT2is) reduce the risk of all-cause mortality, cardiovascular death and hospitalization for heart failure (HF) or chronic kidney disease (CKD) to a greater extent than dipeptidyl peptidase-4 inhibitors (DPP4is) in people with type 2 diabetes (T2D) with or without established cardiovascular and/or renal disease (CVRD). METHODS: This retrospective cohort study propensity-matched 24 438 patients receiving an SGLT2i 1:1 to a patient receiving a DDP4i, stratified based on the presence of CVRD. The primary outcomes were the time to each of the following: all-cause mortality, cardiovascular death or hospitalization for HF, myocardial infarction, stroke and CKD. RESULTS: Overall, SGLT2is were associated with reductions in all-cause mortality, cardiovascular mortality, hospitalization for HF and hospitalization for CKD compared with DPP4is. In patients with no CVRD history, SGLT2is were associated with reductions in all-cause mortality (HR 0.71, 95% CI 0.57-0.88; P = .002), hospitalization for HF (HR 0.76, 95% CI 0.59-0.98; P = .035) and hospitalization for CKD (HR 0.75, 95% CI 0.63-0.88; P < .001). In patients with established cardiovascular disease (CVD) or at high risk, SGLT2is were associated with reductions in all-cause mortality (HR 0.69, 95% CI 0.59-0.82; P < .001), cardiovascular mortality (HR 0.76, 95% CI 0.62-0.95; P = .014), hospitalization for HF (HR 0.73, 95% CI 0.63-0.85; P < .001), hospitalization for stroke (HR 0.75, 95% CI 0.59-0.94; P = .013) and hospitalization for CKD (HR 0.49, 95% CI 0.43-0.54; P < .001). CONCLUSION: There was consistency across subgroups and sensitivity analyses. SGLT2is were associated with a reduced risk of all-cause mortality and hospitalization for HF and CKD compared with DPP4-is, highlighting the need to introduce SGLT2is early in the management of patients with T2D.