Comparative effectiveness of insulin glargine, glucagon‐like peptide‐1 receptor agonists and sodium‐glucose cotransporter‐2 inhibitors in veterans with type 2 diabetes
Authors' conclusion
Insulin glargine might be deleterious particularly in those with HbA1C <9.0%. There was no clear evidence for prioritization of SGLT2i versus GLP-1RA across subgroups.
Study context
- Population
- Veterans with T2D on metformin initiating insulin glargine, GLP-1RA or SGLT2i, 1 January 2018–31 December 2021; followed until 31 March 2023national cohort
- Participants
- 161,405 veterans
- Exposure
- Insulin glargine vs GLP-1 RA vs SGLT2i, added to metformin
- Insulin glarginen = 54,375
- GLP-1RAn = 22,145
- SGLT2in = 84,885
- Outcome
- All-cause death
Methodological detailsactive comparator, new user design, national cohort, inverse probability weighted Cox regression
- Active comparator, new user design
- National cohort
- Inverse probability weighted Cox regression
Main finding
As reported in the abstract
Hazard ratio (95% CI)
Insulin glarginevs GLP-1RA
1.57(1.48–1.67)
Insulin glarginevs SGLT2i
1.55(1.48–1.61)
SGLT2ivs GLP-1RA
1.03(0.97–1.10)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (95% CI) | |
|---|---|---|
| Cardiovascular eventsSGLT2ivs GLP-1RA | 1.13 (1.08–1.19) | |
| 0.512Hazard ratio (log scale) |
Cardiovascular events
- 20 788 cardiovascular events/414 414 person-years
- Results for insulin glargine vs GLP-1RA or SGLT2i were similar for secondary outcomes
All-cause death by subgroup (HbA1c, body mass index (BMI), estimated glomerular filtration rate (eGFR))
- Insulin glargine had higher hazard of all-cause death across subgroups, especially with HbA1c <9.0%
- Across subgroups, GLP-1RA and SGLT2i had generally similar effects, with SGLT2i showing a slightly higher risk in some cases
Original publication
Comparative effectiveness of insulin glargine, glucagon‐like peptide‐1 receptor agonists and sodium‐glucose cotransporter‐2 inhibitors in veterans with type 2 diabetes. Diabetes Obes Metab. Published 30 January 2025. doi:10.
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