T2D: comparison of sulfonylureas, DDP4i and SGLT2i in UK primary care

  • Wilkinson S & al.
  • Diabetes Obes Metab
  • 19 Jan 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with type 2 diabetes (T2D), sodium-glucose co-transporter 2 inhibitors (SGLT2i) was associated with a greater reduction in cardiometabolic risk compared with dipeptidyl peptidase 4 inhibitors (DDP4i) and sulfonylureas (SUs).

Why this matters

  • International guidelines have recommended SGLT2i as an option to intensify glycaemic control after metformin monotherapy along with SUs, thiazolidinedione, DPP4i or GLP-1 receptor agonists as alternate choices.

Study design

  • Study included 10,631 patients with T2D, who received intensified treatment from metformin to SU (n=5010), SGLT2i (n=1187) or DPP4i (n=4434), using data from the UK Clinical Practice Research Datalink (CPRD).
  • Main outcomes: changes in glycated haemoglobin (HbA1c) levels, estimated glomerular filtration rate (eGFR), systolic blood pressure (SBP) and body mass index (BMI) over 96 weeks.
  • Funding: None disclosed.

Key results

  • Over 96 weeks, mean reduction in HbA1c levels was higher with SGLT2i compared with DPP4i (mean difference [MD], −5.4 [95% CI, −7.4 to −3.4] mmol/mol) and SU (MD, −1.7 [95% CI, −3.7 to 0.2] mmol/mol).
  • SGLT2i group had a reduction in SBP compared with DPP4i (MD, −1.82 [95% CI, −3.18 to 0.45] mmHg) and SU (MD, −3.06 [95% CI, −4.43 to 1.68] mmHg) group.
  • Reduction in BMI was higher with SGLT2i compared with DPP4i (MD, −0.92 [95% CI, −1.17 to −0.66] kg/m2) and SU (MD, −1.67 [95% CI, −1.95 to −1.38] kg/m2) group.
  • SGLT2i group was associated with a reduction in eGFR compared with DPP4i (MD, −0.03 [95% CI, −1.01 to 0.94] mL/min/1.73m2) and SU (MD, −0.78 [95% CI, −1.82 to −0.27] mL/min/1.73m2) group.

Limitations

  • Small sample size.