Second-Line Pharmaceutical Treatments for Patients with Type 2 Diabetes
An erratum to this article was published (JAMA Netw Open, 1 Nov 2023 ↗)
Authors' conclusion
These findings highlight familiar medication patterns, including those mirroring randomized clinical trials, as well as providing new insights underscoring the value of robust clinical data analytics in swiftly generating evidence to help guide treatment choices in diabetes.
Study context
- Population
- Patients with diabetes on metformin newly prescribed a second-line agent, University of California Health system EHRs; 5-year monitoring; mean (SD) age 61.4 (12.6) years, 52.2% male
- Participants
- 31,852 new users
- Exposure
- SU, DPP-4i, SGLT2i or GLP-1 RA added to metformin monotherapy
- Outcome
- Time to metabolic failure (HbA1c ≥7.0%)
Methodological detailsmulticenter, new user, multidimensional propensity score-matched, target trial emulation, leave-one-medical-center-out (LOMCO) sensitivity analysis, Data analyzed between January 2022 and April 2023
- Multicenter
- New user
- Multidimensional propensity score-matched
- Target trial emulation
- Leave-one-medical-center-out (LOMCO) sensitivity analysis
- Data analyzed between January 2022 and April 2023
Main finding
As reported in the abstract
Subdistribution hazard ratio (95% CI)
SGLT2Ivs SulfonylureaI2 = 37.5%
0.75(0.69–0.83)
DPP4Ivs SulfonylureaI2 = 0%
0.79(0.75–0.84)
GLP1RAvs SulfonylureaI2 = 23.6%
0.62(0.57–0.68)
SGLT2Ivs GLP1RAI2 = 47.3%; no LOMCO; reported as no significant difference
1.26(1.12–1.42)
SGLT2Ivs DPP4II2 = 0%; no significant difference
0.97(0.90–1.04)
Observational data: associations, not effects.
Further findings
| Outcome | sHR (95% CI) | |
|---|---|---|
| Cardiovascular eventsDPP4Ivs SulfonylureaI2 = 0% | 0.84 (0.74–0.96) | |
| Cardiovascular eventsSGLT2Ivs SulfonylureaI2 = 0% | 0.78 (0.62–0.98) | |
| CKDGLP1RAvs SulfonylureaI2 = 0% | 0.75 (0.6–0.94) | |
| CKDSGLT2Ivs SulfonylureaI2 = 0% | 0.77 (0.61–0.97) | |
| Kidney failureGLP1RAvs SulfonylureaI2 = 9.1% | 0.69 (0.56–0.86) | |
| Kidney failureSGLT2Ivs SulfonylureaI2 = 0% | 0.72 (0.59–0.88) | |
| HypertensionGLP1RAvs SulfonylureaI2 = 0% | 0.82 (0.68–0.97) | |
| HypertensionSGLT2Ivs SulfonylureaI2 = 38.5% | 0.73 (0.58–0.92) | |
| Indicators of chronic hepatic dysfunctionSGLT2Ivs DPP4II2 = 0% | 0.68 (0.49–0.95) | |
| Indicators of chronic hepatic dysfunctionSGLT2Ivs GLP1RAI2 = 0% | 0.66 (0.48–0.91) | |
| Indicators of chronic hepatic dysfunctionSGLT2Ivs SulfonylureaI2 = 0% | 0.60 (0.44–0.81) | |
| 0.512Subdistribution hazard ratio (log scale) |
Safety
| Outcome | sHR (95% CI) | |
|---|---|---|
| New incidence of hypoglycemiaDPP4Ivs SulfonylureaI2 = 22.7% | 0.48 (0.36–0.65) | |
| 0.20.5125Subdistribution hazard ratio (log scale) |
Original publication
Second-Line Pharmaceutical Treatments for Patients with Type 2 Diabetes. JAMA Netw Open. Published 2 October 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →