Comparative effects of second-line oral antidiabetic medications on atrial fibrillation risk in patients with type 2 diabetes: a nationwide retrospective cohort study
Authors' conclusion
This study showed that SGLT2 inhibitor use was associated with a significantly lower risk of AF than use of thiazolidinediones, DPP-4 inhibitors, and sulfonylureas.
Study context
- Population
- Adults with T2D who simultaneously initiated metformin and a second-line oral antidiabetic medication, September 2014–December 2017, National Health Insurance Service data; mean age 55.3 years, 33.6% female774 atrial fibrillation (AF) cases
- Participants
- 36,744 adults
- Exposure
- SGLT2i vs TZD vs DPP-4i vs SU as second-line oral antidiabetic medication with metformin
- Outcome
- Incident AF (Fine-Gray model, all-cause mortality as competing risk)
- Follow-up
- Mean 6.2 years
Methodological detailsnationwide, exact matching by sex and age categories (1:1:5:5), inverse probability of treatment weighting, Fine-Gray competing-risk model
- Nationwide
- Exact matching by sex and age categories (1:1:5:5)
- Inverse probability of treatment weighting
- Fine-Gray competing-risk model
Main finding
As reported in the abstract
Incident AF
Subdistribution hazard ratio (95% CI)
Thiazolidinedionesvs SGLT2 inhibitors
1.22(1.09–1.36)
DPP-4 inhibitorsvs SGLT2 inhibitors
1.14(1.02–1.28)
Sulfonylureasvs SGLT2 inhibitors
1.20(1.07–1.34)
Observational data: associations, not effects.
Further findings
Subgroup analyses of AF risk
- Significant effect modification by age, hypertension status and renal function
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Comparative effects of second-line oral antidiabetic medications on atrial fibrillation risk in patients with type 2 diabetes: a nationwide retrospective cohort study. Cardiovasc Diabetol. Published 30 January 2026. doi:10.
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