Abstract
Aims
We compared cardiovascular outcomes of patients with type 2 diabetes (T2D) receiving
sodium glucose cotransporter-2 inhibitors (SGLT2i) or dipeptidyl peptidase-4 inhibitors
(DPP4i) under routine care.
Methods
From an administrative claims database of >5.2M citizen, we identified patients with
T2D who initiated SGLT2i or DPP4i from 2014 to 2018. Patients were matched by propensity
scores. The primary outcome was the 3-point major adverse cardiovascular events (3P-MACE).
Results
After matching, we included 3216 patients/group, with mean age of 63 years, diabetes
duration of 8.7 years, and 20% had cardiovascular disease. During a median follow-up
of 18 months, the rate of 3P-MACE was lower among patients who initiated SGLT2i versus
DPP4i (HR 0.74; 95 %C.I. 0.58–0.94). Initiators of SGLT2i also showed significantly
lower rates of myocardial infarction (HR 0.75; 95 %C.I. 0.56–1.00), hospitalization
for heart failure (HR 0.44; 95 %C.I. 0.25–0.95) or cardiovascular causes (HR 0.72;
95 %C.I. 0.60–0.87), and all-cause death (HR 0.49; 95 %C.I. 0.25–0.95). Renal failure
was less common with SGLT2i than with DPP4i. Results were consistent to those obtained
in a meta-analysis of 10 observational studies on ~1.5M patients.
Conclusions
Patients with T2D who initiated SGLT2i under routine care had better cardio-renal
outcomes and lower all-cause mortality than similar patients who initiated DPP4i.
Keywords
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Article info
Publication history
Published online: August 25, 2021
Accepted:
August 23,
2021
Received in revised form:
July 15,
2021
Received:
April 7,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
