EASD 2020 — T2D: real-world cardiovascular outcomes of SGLT2 inhibitors vs GLP-1 receptor agonists


  • Suresh Palle
  • Conference Reports
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Takeaway

  • In patients with type 2 diabetes (T2D), sodium-glucose co-transporter-2 inhibitors (SGLT2i) may be more effective than glucagon-like peptide-1 receptor agonists (GLP-1RA) in improving cardiovascular outcomes.

Why this matters

  • In absence of dedicated trials, evidence from this real-world observational study could serve as moderate evidence to guide the best treatment choice for reduced cardiovascular risk in patients with T2D.

Study design

  • This retrospective study included 12,996 patients (mean age, 63 years) with T2D who initiated SGLT2i or GLP-1RA between 2014 and 2018.
  • SGLT2i (n=4298) and GLP-1RA (n=4298) users were matched 1:1 using propensity score matching.
  • Cardiovascular outcomes evaluated were a composite of all-cause death, myocardial infarction (MI) and stroke (3-point major adverse cardiovascular events [3P-MACE]); hospitalization for heart failure (HHF); revascularization; and hospitalization for cardiovascular diseases (CVD).
  • Funding: None.

Key results

  • GLP-1RA reduced HbA1c more than SGLT2i, whereas SGLT2i improved systolic blood pressure and high-density lipoprotein cholesterol better than GLP-1RA.
  • In ‘as-treated’ analysis, SGLT2i vs GLP-1RA significantly reduced risk for:
    • 3P-MACE: HR, 0.78; 95% CI, 0.61-0.99; P=.043;
    • HHF: HR, 0.59; 95% CI, 0.35-0.99; P=.048; and
    • hospitalization for CVD: HR, 0.82; 95% CI, 0.69-0.99; P=.037.
  • Among 3P-MACE components, the strongest difference between the 2 groups was found for MI (HR, 0.72; 95% CI, 0.53-0.98; P=.035).
  • Results were similar in intention-to-treat analysis:
    • 3P-MACE: HR, 0.78; 95% CI, 0.62-0.97; P=.027; and
    • MI: HR, 0.75; 95% CI, 0.56-0.98; P=.039.
  • SGLT2i vs GLP-1RA was associated with lower rates of 3P-MACE among patients with baseline CVD (HR, 0.70; 95% CI, 0.49-0.99; P=.049) and lower HHF rates among patients without CVD (HR, 0.39; 95% CI, 0.15-0.99; P=.048).
  • Overall, adverse events were not significantly different between the 2 groups, but a trend towards lower risk for renal events was found with SGLT2i vs GLP-1RA (acute kidney injury: HR, 0.55; 95% CI, 0.28-1.09; P=.086).

Limitations

  • Retrospective design.
  • Laboratory values were available only for a subset of patients.