Outcomes of SGLT-2i and GLP-1RA Therapy Among Patients With Type 2 Diabetes and Varying Nonalcoholic Fatty Liver Disease (NAFLD) Status
Authors' conclusion
In this population-based cohort study, SGLT-2i therapy was associated with a decreased risk of MACE and HHF, while GLP-1RA therapy was associated with a decreased risk of MACE among patients with T2D, irrespective of baseline NAFLD status.
Study context
- Population
- Patients aged ≥40 years with T2D, with or without NAFLD, South Korea, January 2013–December 2020two matched cohorts
- Exposure
- SGLT2i or GLP-1 RA vs DPP-4i, by NAFLD status
- Outcome
- (1) MACE: hospitalization for MI, hospitalization for stroke and cardiovascular death; (2) hospitalization for HF (HHF)
Methodological detailspopulation-based, nationwide, active-comparator new-user design, 1:1 propensity score matched, Data analysis October 2022 to March 2023
- Population-based
- Nationwide
- Active-comparator new-user design
- 1:1 propensity score matched
- Data analysis October 2022 to March 2023
Main finding
As reported in the abstract
Each group vs DPP-4iHazard ratio (95% CI)
SGLT-2iMACE; 140 438 matched patients
0.78(0.71–0.85)
SGLT-2iHHF
0.62(0.48–0.81)
GLP-1RAMACE; 34 886 matched patients
0.49(0.39–0.62)
GLP-1RAHHF; statistically nonsignificant
0.64(0.39–1.07)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| MACE and HHF stratified by NAFLD statusSGLT-2ivs DPP-4iMACE, with NAFLD | 0.73 (0.62–0.86) | |
| MACE and HHF stratified by NAFLD statusSGLT-2ivs DPP-4iMACE, without NAFLD | 0.81 (0.72–0.91) | |
| MACE and HHF stratified by NAFLD statusSGLT-2ivs DPP-4iHHF, with NAFLD | 0.76 (0.49–1.17) | |
| MACE and HHF stratified by NAFLD statusSGLT-2ivs DPP-4iHHF, without NAFLD | 0.56 (0.40–0.78) | |
| MACE and HHF stratified by NAFLD statusGLP-1RAvs DPP-4iMACE, with NAFLD | 0.49 (0.32–0.77) | |
| MACE and HHF stratified by NAFLD statusGLP-1RAvs DPP-4iMACE, without NAFLD | 0.49 (0.37–0.65) | |
| MACE and HHF stratified by NAFLD statusGLP-1RAvs DPP-4iHHF, with NAFLD | 0.82 (0.38–1.76) | |
| MACE and HHF stratified by NAFLD statusGLP-1RAvs DPP-4iHHF, without NAFLD | 0.54 (0.27–1.06) | |
| 0.20.5125Hazard ratio (log scale) |
Major adverse cardiovascular events (MACE) and hospitalization for heart failure (HHF) stratified by NAFLD status
- Stratified analysis by NAFLD status yielded consistent results
Original publication
Outcomes of SGLT-2i and GLP-1RA Therapy Among Patients With Type 2 Diabetes and Varying NAFLD Status. JAMA Netw Open. Published 1 December 2023. doi:10.
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