Type 2 diabetes, sodium-glucose cotransporter-2 inhibitors and cardiovascular outcomes: real world evidence versus a randomised clinical trial
Main finding · MACEResult — go to the resultRisk difference 2.8 percentage-points 95% CI 1.1–4.4%Authors' conclusion
This study demonstrates the real-world effectiveness of continuous SGLT2i treatment in reducing cardiovascular events in patients with T2D and CVD. The absolute benefit of SGLT2i was larger in a real world population than in the intention to treat estimate in clinical trials.
Study context
- Population
- Individuals with T2D and cardiovascular disease (CVD), Denmarkof 116,823 first-time users
- Participants
- 13,524 individuals
- Exposure
- SGLT2i vs DPP4i
- SGLT2in = 6,025
- DPP4in = 7,499reference
- Outcome
- Major adverse cardiovascular events (MACE)
- Follow-up
- 3 years
Methodological detailsnationwide registry-based cohort study, nationwide Danish registries, longitudinal targeted minimum loss-based estimation, adjusted for baseline and time-varying confounders, continuous treatment (on-treatment) estimand
- Nationwide registry-based cohort study
- Nationwide Danish registries
- Longitudinal targeted minimum loss-based estimation
- Adjusted for baseline and time-varying confounders
- Continuous treatment (on-treatment) estimand
Main finding
As reported in the abstract
Risk difference
2.8 percentage-points
95% CI 1.1–4.4%
By group
DPP4ivs SGLT2i
risk difference 2.8 percentage-points (95% CI 1.1–4.4%)
Observational data: associations, not effects.
Further findings
| Outcome | Risk difference (percentage-points) (95% CI) | |
|---|---|---|
| HF hospitalizations · 3 yearsLower with SGLT2i | 5.1 (4.3–6.0%) | |
| All-cause mortality · 3 yearsLower with SGLT2i | 3.1 (1.5–4.7%) | |
| −50510Difference, percentage-points (linear scale) |
Stroke
- Risk reduction in stroke
- 2.4 percentage-points (95% CI: 1.7-3.1%)
Original publication
Type 2 diabetes, sodium-glucose cotransporter-2 inhibitors and cardiovascular outcomes: real world evidence versus a randomised clinical trial. Cardiovasc Diabetol. Published 30 September 2025. doi:10.
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