Mortality, kidney, and safety outcomes with SGLT2 inhibitors versus DPP4 inhibitors in patients with type 2 diabetes treated with systemic glucocorticoids: a real-world exploratory study
Main finding · All-cause deathResult — go to the resultRelative risk 0.73 95% CI 0.64–0.84Authors' conclusion
In a global real-world cohort of patients with type 2 diabetes treated with systemic glucocorticoids, SGLT2 inhibitors versus DPP4 inhibitors initiation was associated with a lower rate of all-cause death, with evidence suggesting kidney benefits.
Study context
- Population
- Adults with T2D and estimated glomerular filtration rate (eGFR) > 30 mL/min/1.73 m² treated with oral glucocorticoids, initiating SGLT2i or DPP-4i (2015–2021); mean age 60.1 years, mean eGFR 82.4 mL/min/1.73 m²matched
- Participants
- 9,090 adults
- Exposure
- SGLT2i vs DPP-4i initiation
- Outcome
- All-cause death
Methodological detailspropensity-score matched (1:1), real-world data network (TriNetX), exploratory
- Propensity-score matched (1:1)
- Real-world data network (TriNetX)
- Exploratory
Main finding
As reported in the abstract
Relative risk
0.73
95% CI 0.64–0.84
Events by group
SGLT2 inhibitors
315
events
DPP4 inhibitors
433
events
SGLT2 inhibitorsvs DPP4 inhibitors
RR 0.73 (95% CI 0.64–0.84)
Observational data: associations, not effects.
Further findings
Events
| Outcome | SGLT2 inhibitors | DPP4 inhibitors | RR (CI) | |
|---|---|---|---|---|
| Composite kidney outcome: CKD stage 4 or worse, eGFR < 30 mL/min/1.73 m², or dialysis initiation | 421 | 518 | 0.81 (0.72–0.92) | |
| 0.512Relative risk (log scale) |
Safety
Diabetic ketoacidosis
- Patients with diabetic ketoacidosis, SGLT2i vs DPP-4i (respective numbers)
- 67 versus 59
Genital tract infections (in women)
- Patients with genital tract infections, SGLT2i vs DPP-4i (respective numbers)
- 125 versus 119
Original publication
Mortality, kidney, and safety outcomes with SGLT2 inhibitors versus DPP4 inhibitors in patients with type 2 diabetes treated with systemic glucocorticoids: a real-world exploratory study. Diabetes Res Clin Pract. Published 23 June 2025. doi:10.
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