Cardiovascular and mortality benefits of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists as third-step glucose-lowering medicine in patients with type 2 diabetes: a retrospective cohort analysis
Authors' conclusion
Third-step SGLT2 and GLP1 are generally associated with a benefit for these outcomes in these patient groups when compared with third-step DPP4, insulin, or TZD. Our results add to evidence of a cardiovascular benefit of SGLT2 and GLP1 and could inform clinical guidelines for choosing third-step diabetes treatment.
Study context
- Population
- Adults with T2D and atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD) or heart failure (HF) initiating third-step glucose-lowering treatment between 2016 and 2020, five Kaiser Permanente sites
- Participants
- 27,542 adults
- Exposure
- Third-step SGLT2i or GLP-1 RA vs third-step DPP-4i, insulin or thiazolidinediones (TZD)
- Outcome
- All-cause mortality, incident MACE and incident HF hospitalization (adjusted rate ratios)
Methodological detailsfive Kaiser Permanente sites, propensity score weighted Poisson models
- Five Kaiser Permanente sites
- Propensity score weighted Poisson models
Main finding
As reported in the abstract
Adjusted rate ratios, GLP1 and SGLT2 vs DPP4, insulin and TZD, across patient subgroups
ARR range, all-cause mortality
0.22–0.55
ARR range, major adverse cardiovascular event (MACE)
0.38–0.81
ARR range, HF hospitalization
0.46–1.05
Observational data: associations, not effects.
Further findings
Subgroup sizes by comorbidity
- With ASCVD
- 19 958
- With CKD
- 14 577
- With HF
- 3919
Original publication
Cardiovascular and mortality benefits of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists as third-step glucose-lowering medicine in patients with type 2 diabetes: a retrospective cohort analysis. BMJ Open Diabetes Res Care. Published 6 May 2024. doi:10.
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