Cardiovascular and renal outcomes among patients with type 2 diabetes using SGLT2 inhibitors added to metformin: a population-based cohort study from the UK
Authors' conclusion
In this population-based study, SGLT2is were associated with significant CV, renal and survival benefits among individuals with type 2 diabetes on metformin; the CV benefit was driven by a reduced risk of ischemic stroke.
Study context
- Population
- Patients with T2D prescribed metformin, UK primary care; mean age 59.6 years (SGLT2i) and 60.4 years (comparator)matched cohort
- Participants
- 12,978 vs 44,286
- Exposure
- SGLT2i added to metformin vs matched comparator not using SGLT2i
- SGLT2isn = 12,978
- Comparatorn = 44,286reference
- Outcome
- Cardiovascular (CV) composite (non-fatal MI/ischemic stroke requiring hospitalization and CV death), severe renal disease, and all-cause mortality
- Follow-up
- Mean 2.3 years (SGLT2i) and 2.1 years (comparator)
Methodological detailsmatched comparator, UK primary care electronic health records
- Matched comparator
- UK primary care electronic health records
Main finding
As reported in the abstract
CV composite
Each group vs comparatorEstimate (95% CI)
SGLT2is
adjusted HR 0.75(0.61–0.93)
SGLT2is
adjusted HR (severe renal disease) 0.55(0.46–0.67)
SGLT2is
adjusted HR (all-cause mortality) 0.56(0.49–0.63)
Observational data: associations, not effects.
Further findings
Ischemic stroke
- Reduced risk of ischemic stroke (IS), HR
- 0.51 (0.36 to 0.74) (95% CI)
Myocardial infarction (MI)
- No reduced risk of MI, HR
- 0.98 (0.74 to 1.28) (95% CI)
Baseline CKD subgroups
- Risk reductions similar irrespective of baseline CKD
Sensitivity analyses
- Results consistent in sensitivity analyses
Original publication
Cardiovascular and renal outcomes among patients with type 2 diabetes using SGLT2 inhibitors added to metformin: a population-based cohort study from the UK. BMJ Open Diabetes Res Care. Published 3 January 2023. doi:10.
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