Lower Risk of Hospitalisation for Heart Failure, Kidney Disease and Death with Sodium Glucose Co-Transporter-2 Compared to Dipeptidyl Peptidase-4 Inhibitors in Type 2 Diabetes Regardless of Prior Cardiovascular or Kidney Disease: A Retrospective Cohort Study in UK Primary Care.

Background

Sodium–glucose cotransporter–2 inhibitors (SGLT2i) reduce the risk of cardiovascular and, or renal disease (CVRD). Dipeptidyl peptidase–4 inhibitors (DPP4i) have not shown these effects.

Methods

This retrospective cohort study propensity matched 24,438 patients receiving a SGLT2i 1:1 to a person receiving a DDP4i, stratified based on presence of CVRD. Primary outcomes were the time to each of the following: all–cause mortality, cardiovascular death or hospitalisation for heart failure (HF), myocardial infarction, stroke and chronic kidney disease (CKD).

Findings

Overall, SGLT2i were associated with reductions in all–cause mortality, cardiovascular mortality , HF hospitalisation and CKD hospitalisation compared with DPP4i. In patients with no CVRD history, SGLT2i were associated with reductions in all–cause mortality (0·71, 0·57–0·88; p=0·002), HF hospitalisation (0·76, 0·59–0·98; p=0·035) and CKD hospitalisation (0·75, 0·63–0·88; p<0·001). In patients with established cardiovascular disease (CVD) or at high risk, SGLT2i were associated with reductions in all–cause mortality (0·69, 0·59–0·82); p<0·001), cardiovascular mortality (0·76, 0·62–0·95; p=0·014), HF hospitalisation (0·73, 0·63–0·85; p<0·001), stroke hospitalisation (0·75, 0·59–0·94, p=0·013) and CKD hospitalisation (0·49, 0·43–0·54, p<0·001). Results were consistent across subgroups and sensitivity analyses.

Interpretation

SGLT2i were associated with reduced risk of all–cause mortality and hospitalisation for HF and CKD compared with DPP4–i, highlighting the need to introduce SGLT2i early in the management of T2D patients.