SGLT2is lower cardiorenal risk in T2D patients without cardiovascular and renal disease

  • Birkeland KI & al.
  • Diabetes Obes Metab
  • 7 Sep 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Sodium-glucose cotransporter-2 inhibitors (SGLT2is) use was associated with a lower risk of heart failure (HF) and chronic kidney disease (CKD) vs dipeptidyl peptidase-4 inhibitors (DPP4is) in type 2 diabetes (T2D) patients free from cardiovascular (CV) and renal disease (CVRD), managed in routine clinical practice.

Why this matters

  • Cardiorenal disease risk-lowering effects of SGLT2is reported in clinical trials translate to a multinational real-world setting.
  • Findings support increased clinical focus on identifying and implementing early cardiorenal prevention strategies in the treatment of patients with T2D at the risk for cardiorenal events.

Study design

  • In this multinational observational study, CVRD-free new users of SGLT2is or DPP4is were propensity score-matched in a ratio of 1:1 (n=105,130 in each group) with a total follow-up of 187,955 patient-years.
  • Main outcomes: CVRD (diagnosis of HF and CKD), HF, CKD, stroke, myocardial infarction (MI), all-cause and CV mortality.
  • Funding: AstraZeneca.

Key results

  • Dapagliflozin (91.7%) and sitagliptin/linagliptin (55.0%) were the most commonly used agents in the SGLT2is and DPP4is group, respectively.
  • SGLT2is vs DPP4is were associated with a lower risk of:
    • CVRD (HR, 0.56; 95% CI, 0.42-0.74);
    • HF (HR, 0.71; 95% CI, 0.59-0.86);
    • CKD (HR, 0.44; 95% CI, 0.28-0.69); and
    • all-cause (HR, 0.67; 95% CI, 0.59-0.77) and CV (HR, 0.61; 95% CI, 0.44-0.85) mortality.
  • No differences were observed in the risk of stroke (HR, 0.87; 95% CI, 0.69-1.09) and MI (HR, 0.94; 95% CI, 0.80-1.11) between both groups.

Limitations

  • Findings cannot be extended to all patients with T2D.