Comparative Cardiovascular Effectiveness and Safety of SGLT-2 Inhibitors, GLP-1 Receptor Agonists, and DPP-4 Inhibitors According to Frailty in Type 2 Diabetes
Authors' conclusion
SGLT-2is and GLP-1RAs safely improved cardiovascular outcomes and all-cause mortality, with the largest absolute benefits among frail people.
Study context
- Population
- Older adults with T2D, Medicare beneficiaries (2013–2019), initiating SGLT2i, GLP-1 RA or DPP-4i, across frailty stratamatched pairs per cohort
- Exposure
- SGLT2i vs DPP-4i, GLP-1 RA vs DPP-4i, and SGLT2i vs GLP-1 RA, by frailty
- Outcome
- Primary cardiovascular effectiveness composite outcome:
- Acute MI
- Ischemic stroke
- Hospitalization for HF
- All-cause mortality
Methodological detailsthree 1:1 propensity score-matched cohorts, stratified by three frailty strata, time-to-event analyses
- Three 1:1 propensity score-matched cohorts
- Stratified by three frailty strata
- Time-to-event analyses
Main finding
As reported in the abstract
Each group vs DPP-4isHazard ratio (95% CI)
SGLT-2isoverall; n = 120,202 matched pairs
0.72(0.69–0.75)
GLP-1RAsoverall; n = 113,864
0.74(0.71–0.77)
Incidence rate difference (IRD)
- SGLT-2is · overall
- −13.35 (95% CI −15.06 to −11.64)
- GLP-1RAs · overall
- −15.49 (95% CI −17.46 to −13.52)
- IRD ranged from −6.74 (95% CI −8.61 to −4.87) in nonfrail to −27.24 (95% CI −41.64 to −12.84) in frail people
- P for interaction < 0.01
- IRD in the lowest frailty stratum was −7.02 (95% CI −9.23 to −4.81) and −25.88 (95% CI −38.30 to −13.46) in the highest
- P for interaction < 0.01
Observational data: associations, not effects.
Safety
Composite of severe adverse events linked to SGLT2i or GLP-1 RA use
- Severe adverse events were not more frequent with SGLT-2is or GLP-1RAs than DPP-4is
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Comparative Cardiovascular Effectiveness and Safety of SGLT-2 Inhibitors, GLP-1 Receptor Agonists, and DPP-4 Inhibitors According to Frailty in Type 2 Diabetes. Diabetes Care. Published 7 September 2023. doi:10.
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