Effectiveness and safety of sodium‐glucose co‐transporter‐2 inhibitors compared with dipeptidyl peptidase‐4 inhibitors in older adults with type 2 diabetes: A nationwide population‐based study

Abstract

Aim To examine the real‐world cardiovascular effectiveness and safety associated with sodium‐glucose co‐transporter‐2 (SGLT2) inhibitor compared with dipeptidyl peptidase‐4 (DPP‐4) inhibitor treatment in older adults with type 2 diabetes. Materials and Methods In this retrospective cohort study, older adults with type 2 diabetes (aged ≥65 years) were identified in the Korean National Health Insurance Service database from September 2014 to December 2016. In total, 408 506 new users of an SGLT2 inhibitor or DPP‐4 inhibitor were propensity score matched. Cox regression was used to estimate the hazard ratios (HR) and 95% confidence interval (CI) for outcomes of interest: hospitalization for heart failure (HHF), all‐cause death, myocardial infarction, stroke, diabetic ketoacidosis (DKA), bone fracture, severe hypoglycaemia, genital infection and urinary tract infection (UTI). Results Compared with DPP‐4 inhibitors, new users of SGLT2 inhibitors had a lower risk of HHF (HR 0.86; 95% CI 0.76‐0.97), all‐cause death (HR 0.85; 95% CI 0.75‐0.98) and stroke (HR 0.86; 95% CI 0.77‐0.97), but a similar risk of myocardial infarction (HR 0.95; 95% CI 0.77‐1.19). The risks of DKA, bone fracture and severe hypoglycaemia were similar between both groups, although genital infection (HR 2.44; 95% CI 2.22‐2.67) and UTI (HR 1.05; 95% CI 1.00‐21.11) were more frequent among new users of SGLT2 inhibitors compared with DPP‐4 inhibitors. Conclusion Our findings suggest that initiation of SGLT2 inhibitors offers cardiovascular disease protection and can be used safely in older adults with type 2 diabetes.

Comparative Effectiveness of Sodium-Glucose Cotransporter 2 Inhibitors vs the Other Hypoglycemic Drugs on Major Adverse Cardiovascular Events and Hospitalization for Heart Failure in Patients with Type 2 Diabetes Mellitus and Atrial Fibrillation

“…[24,25] In the present study, SGLT2 inhibitors use was associated with a signi cant reduction in all-cause mortality but not in cardiovascular mortality. Recently, two studies on Korean T2DM patients also reported that new users of SGLT2 inhibitors had a lower risk of all-cause mortality than those who received other hypoglycemic drugs; [19,26] however, these studies did not evaluate the risk of cardiovascular mortality. [19,26] In the present study, we found a discrepancy in the effect of SLGT2 inhibitors for cardiovascular and allcause mortalities.…”

“…Recently, two studies on Korean T2DM patients also reported that new users of SGLT2 inhibitors had a lower risk of all-cause mortality than those who received other hypoglycemic drugs; [19,26] however, these studies did not evaluate the risk of cardiovascular mortality. [19,26] In the present study, we found a discrepancy in the effect of SLGT2 inhibitors for cardiovascular and allcause mortalities. Unfortunately, we cannot explain the exact reason for this discrepancy, but we assume that the following mechanisms may be involved.…”

“…Initially, we identi ed patients with T2DM (ICD-10 codes E11-E14) [19] and AF (ICD-10 codes I48) who were prescribed hypoglycemic drugs between January 2014 and December 2018. We then extracted patients who were newly prescribed hypoglycemic drugs since January 2014 because the Korean government insurance began reimbursing SGLT2 inhibitors as secondary hypoglycemic drugs for T2DM from September 2014.…”

Management of type 2 diabetes mellitus in older adults: eight case studies with focus SGLT-2 inhibitors and metformin

“…Noteworthy, safety results were similar across these age groups. Accordingly, while more research is warranted to question this agerelated preferential benefit of SGLT-2 inhibitors, this possible lack of non-diabetic benefits in oldest-old individuals should be considered [23].…”

Role of stilbenes against insulin resistance: A review

“…Other classes of drugs used in the T2D treatment plan include dipeptidyl peptidase‐4 inhibitors, an alpha‐glucosidase inhibitor, and sodium–glucose cotransporter‐2 inhibitors. These groups of medications have side effects including respiratory tract infections, joint pain, abdominal cramping, diarrhea, increased urination, and thirst (Han et al., 2021 ).…”