Effectiveness of Sodium–Glucose Cotransporter-2 Inhibitors Versus Glucagon-like Peptide-1 Receptor Agonists on Diabetic Foot Disease : An Emulated Target Trial
Main finding · Any foot diseaseResult — go to the resultRelative risk 0.90 95% CI 0.84–0.97Authors' conclusion
New SGLT-2i users had a modestly lower risk for foot disease largely driven by a lower risk for neuropathy than GLP-1RA users.
Study context
- Population
- Patients with T2D initiating SGLT2i or GLP-1 RA, Danish national health care registry data 2013–2023, plus a convenience sample from a research cohort with additional behavioral and clinical assessmentsregistry cohort
- Participants
- 53,769 vs 30,380
- Exposure
- SGLT2i vs GLP-1 RA new users
- SGLT-2isn = 53,769
- GLP-1RAsn = 30,380reference
- Outcome
- Incident foot disease (peripheral neuropathy, peripheral artery disease, foot ulcers or lower-limb amputation) as defined by the International Working Group on the Diabetic Foot
- Follow-up
- 6 years
Methodological detailspopulation-based, inverse probability of treatment-weighted, adjusted for 45 demographic, clinical and other factors
- Population-based
- Inverse probability of treatment-weighted
- Adjusted for 45 demographic, clinical and other factors
Main finding
Any foot disease · 6 years
Relative risk
0.90
95% CI 0.84–0.97
By group
SGLT-2isvs GLP-1RAs
RR 0.90 (95% CI 0.84–0.97)
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | RR (CI) | |
|---|---|---|
| Neuropathy | 0.78 (0.68–0.87) | |
| 0.512Relative risk (log scale) |
Discontinued initial treatment · after year 3
Peripheral artery disease, foot ulcers, amputations and all-cause mortality
- Similar risks with SGLT-2is and GLP-1RAs
Original publication
Effectiveness of Sodium–Glucose Cotransporter-2 Inhibitors Versus Glucagon-like Peptide-1 Receptor Agonists on Diabetic Foot Disease : An Emulated Target Trial. Ann Intern Med. Published 6 January 2026. doi:10.
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