Risk of severe lower extremity arterial disease in elderly Japanese patients with type 2 diabetes: a propensity score-matched model analysis of sodium-glucose cotransporter 2 inhibitors versus metformin
Authors' conclusion
The endothelial benefits of metformin, achieved without affecting hemodynamics, may be particularly effective in elderly patients with T2D and low dBP or impaired renal function. However, the presence of cardiovascular disease may often lead to the selection of SGLT2is. Nevertheless, prioritizing the use of metformin may be prudent when considering LEAD status.
Study context
- Population
- Patients aged ≥65 years with T2D and advanced-age health insurance coverage, Japan; insurance claims and health check-up datamatched cohort
- Participants
- 31,732 patients
- Exposure
- SGLT2i vs metformin
- SGLT2isn = 15,866
- Metforminn = 15,866reference
- Outcome
- Severe LEAD (revascularization after LEAD diagnosis)
- Follow-up
- 3 years
Methodological detailspropensity score matched, claims database
- Propensity score matched
- Claims database
Main finding
As reported in the abstract
Severe LEAD incidence
Metformin
2.10 per 1,000 person-years
SGLT2is
2.69 per 1,000 person-years
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Severe LEAD, subgroup dBP <80 mm Hg | 2.11 (1.01–2.30) | |
| Severe LEAD, subgroup eGFR 30–60 mL/min/1.73 m² | 2.32 (1.09–2.94) | |
| 0.20.5125Hazard ratio (log scale) |
Original publication
Risk of severe lower extremity arterial disease in elderly Japanese patients with type 2 diabetes: a propensity score-matched model analysis of sodium-glucose cotransporter 2 inhibitors versus metformin. BMJ Open Diabetes Res Care. Published 17 July 2025. doi:10.
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