Downstream Treatment Burden and Health‐Care Utilization Following Initiation of GLP ‐1 Receptor Agonists or SGLT2 Inhibitors in Type 2 Diabetes
Authors' conclusion
Initiation of GLP-1 receptor agonists is associated with a downstream pharmacologic cascade characterized by increased use of symptom-driven medication without corresponding increases in health-care utilization. Medication initiation may provide a more sensitive measure of treatment burden than diagnostic codes or utilization metrics in routine diabetes care. To our knowledge, this study represents the largest multicentre real-world evaluation of downstream pharmacologic cascades following initiation of GLP-1 receptor agonists and SGLT2 inhibitors.
Study context
- Population
- Adults with T2D newly initiating a GLP-1 RA or an SGLT2i between 1 January 2017 and 1 June 2025, multi-centre electronic health record network1:1 matched
- Exposure
- GLP-1 RA vs SGLT2i initiation
- GLP-1n = approximately 164,000
- SGLT2n = approximately 164,000reference
- Outcome
- Initiation of seven downstream medication classes
Methodological detailspropensity score-matched, 1:1 matching, multi-centre electronic health record network, outcome-specific baseline-free cohorts with uniform washout periods
- Propensity score-matched
- 1:1 matching
- Multi-centre electronic health record network
- Outcome-specific baseline-free cohorts with uniform washout periods
Main finding
As reported in the abstract
Antidepressant initiation: absolute risk difference
3.38%
95% CI −3.61 to −3.15
Antidepressant initiation: HR
0.78
95% CI 0.76–0.80
Observational data: associations, not effects.
Secondary outcomes
Gastrointestinal and nutritional diagnoses
- Differences in secondary diagnoses were smaller
- Gastroesophageal reflux disease and esophagitis more common after GLP-1 initiation
- Peptic ulcer disease and endoscopic procedures more frequent among SGLT2 initiators
- Nutrient deficiency and unspecified anaemia more frequent following GLP-1 therapy
Health-care utilization
- Overall health-care utilization similar, except inpatient acute care, more frequent among SGLT2 initiators
Original publication
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