SGLT-2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors and risk of hyperkalemia among people with type 2 diabetes in clinical practice: population based cohort study
Authors' conclusion
In people with type 2 diabetes, SGLT-2 inhibitors and GLP-1 receptor agonists were associated with a lower risk of hyperkalemia than DPP-4 inhibitors in the overall population and across relevant subgroups. The consistency of associations among individual agents in the SGLT-2 inhibitor and GLP-1 receptor agonist classes suggests a class effect. These ancillary benefits of SGLT-2 inhibitors and GLP-1 receptor agonists further support their use in people with type 2 diabetes, especially in those at risk of hyperkalemia.
Study context
- Population
- Adults with T2D newly starting SGLT2i, GLP-1 RA or DPP-4i; Medicare and two large US commercial insurance claims databases, April 2013 to April 2022; matched pairs SGLT2i vs DPP-4i, GLP-1 RA vs DPP-4i, SGLT2i vs GLP-1 RAthree 1:1 matched cohorts · matched pairs SGLT2i vs DPP-4i 778,908 · GLP-1 RA vs DPP-4i 729,820 · SGLT2i vs GLP-1 RA 873,460
- Exposure
- SGLT2i vs DPP-4i, GLP-1 RA vs DPP-4i, and SGLT2i vs GLP-1 RA
- Outcome
- Hyperkalemia diagnosis in the inpatient or outpatient setting
Methodological detailsactive-comparator, new user design, 1:1 propensity score matched
- Active-comparator, new user design
- 1:1 propensity score matched
Main finding
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
Secondary outcomes (serum potassium ≥5.5 mmol/L; hyperkalemia diagnosis in inpatient or ED setting) and subgroups
- Findings consistent for secondary outcomes and among subgroups by age, sex, race, medical conditions, other drug use and HbA1c on the relative scale
- Absolute benefits of SGLT2i and GLP-1 RA largest with HF, CKD or mineralocorticoid receptor antagonist use
Individual agents vs DPP-4i
- Lower hyperkalemia rate consistent across canagliflozin, dapagliflozin, empagliflozin, dulaglutide, exenatide, liraglutide and semaglutide
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
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