The use of sodium-glucose co-transporter-2 inhibitors or glucagon-like peptide-1 receptor agonists versus sulfonylureas and the risk of lower limb amputations: a nation-wide cohort study
Authors' conclusion
SGLT2-I use was not associated with a higher risk of LLA, but GLP1-RAs with a lower risk of LLA. Previous studies reporting a higher risk of LLA with SGLT2-I use compared to GLP1-RA use might have been looking at a protective GLP1-RA effect, rather than a harmful SGLT2-I effect.
Study context
- Population
- T2D patients aged 18+ with a first ever prescription of an SGLT2i, GLP-1 RA or SU, Danish National Health Service data (2013–2018)
- Participants
- 74,475 patients
- Exposure
- Current SGLT2i use and GLP-1 RA use vs current SU use
- Outcome
- Lower limb amputation (LLA)
Methodological detailsnation-wide, time-varying Cox proportional hazards models, adjusted for age, sex, socio-economic variables, comorbidities and concomitant drug use
- Nation-wide
- Time-varying Cox proportional hazards models
- Adjusted for age, sex, socio-economic variables, comorbidities and concomitant drug use
Main finding
As reported in the abstract
LLA
Each group vs sulfonylureasAdjusted hazard ratio (95% CI)
SGLT2-Inot associated with higher risk
1.10(0.71–1.70)
GLP1-RAlower risk
0.57(0.39–0.84)
Observational data: associations, not effects.
Further findings
- Risk of diabetic foot ulcer (DFU) similar to SU with both SGLT2i and GLP-1 RA use
Original publication
The use of sodium-glucose co-transporter-2 inhibitors or glucagon-like peptide-1 receptor agonists versus sulfonylureas and the risk of lower limb amputations: a nation-wide cohort study. Cardiovasc Diabetol. Published 29 June 2023. doi:10.
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