SGLT2i use in patients with type 2 diabetes without prior vascular disease was associated with a lower risk of coronary artery disease compared to DPP-4 inhibitors (HR 0.80; 95% CI 0.73-0.87).
Cohort (n=1,145,035)
Does SGLT2i use reduce the risk of incident cardiovascular diseases, major microvascular complications, and mortality in patients with type 2 diabetes without existing macrovascular or microvascular diseases compared to other glucose-lowering drugs?
In a large real-world cohort of patients with type 2 diabetes without prior cardiovascular or microvascular disease, SGLT2 inhibitors were associated with significantly lower risks of incident cardiovascular events, microvascular complications, and mortality compared to DPP-4 inhibitors, sulfonylureas, and GLP-1 RAs.
Hazard Ratio: 0.8 (95% CI 0.73–0.87)
OBJECTIVE: This study aimed to evaluate the different risks of developing cardiovascular disease and major microvascular complications between sodium-glucose cotransporter-2 inhibitors (SGLT2i) and non-SGLT2i users in patients with type 2 diabetes (T2D) who do not have existing macrovascular or microvascular diseases. DESIGN: This study employed a retrospective, population-based cohort study design. SETTING: Data were obtained from Taiwan's National Health Insurance Research Database, covering the period from January 1, 2008, to December 31, 2021. Propensity score matching was used to identify 91,327 matched pairs of SGLT2 inhibitor and dipeptidyl peptidase-4 (DPP-4) inhibitor users, 91,673 pairs of SGLT2 inhibitor and sulfonylurea users, and 20,857 pairs of SGLT2 inhibitor and glucagon-like peptide-1 receptor agonist (GLP-1 RA) users. PARTICIPANTS: The study included 1,145,035 patients diagnosed with T2D from the NHIRD. MAIN OUTCOME MEASURES: Cox proportional hazard models were used to assess the risk of outcomes. RESULTS: SGLT2i users showed a lower risk of coronary artery disease (0.80 (0.73-0.87), 0.78 (0.72-0.85) and 0.74 (0.64-0.86)), heart failure (0.44 (0.38-0.49), 0.56 (0.50-0.62) and 0.66 (0.55-0.78)), cardiovascular death (0.47 (0.40-0.56), 0.47 (0.40-0.55) and 0.68 (0.53-0.87)), dialysis (0.03 (0.02-0.05), 0.13 (0.10-0.17) and 0.16 (0.11-0.23)), vision-threatening retinopathy (0.58 (0.51-0.67), 0.59 (0.51-0.67) and 0.78 (0.62-0.98)), amputation (0.29 (0.20-0.41), 0.28 (0.21-0.38) and 0.61 (0.46-0.89)) and all-cause mortality (0.42 (0.39-0.445), 0.39 (0.37-0.42) and 0.68 (0.61-0.76]))when compared to DPP-4 inhibitors, sulfonylureas, and GLP-1 RA users, respectively. CONCLUSIONS: This study showed that SGLT2i use was associated with a lower risk of incident cardiovascular diseases, major microvascular complications and mortality compared with the use of DPP-4 inhibitors, sulfonylureas and GLP-1 RA in patients with T2D, who did not have macrovascular and microvascular diseases.
Cheng et al. (Sat,) conducted a cohort in Type 2 diabetes without existing macrovascular or microvascular diseases (n=1,145,035). Sodium-glucose cotransporter-2 inhibitors (SGLT2i) vs. DPP-4 inhibitors, sulfonylureas, and GLP-1 RA was evaluated on Coronary artery disease (HR 0.80, 95% CI 0.73-0.87). SGLT2i use in patients with type 2 diabetes without prior vascular disease was associated with a lower risk of coronary artery disease compared to DPP-4 inhibitors (HR 0.80; 95% CI 0.73-0.87).
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