Risk of hyperkalaemia in patients with type 2 diabetes mellitus prescribed with SGLT2 versus DPP-4 inhibitors.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: Oxford University Press Country of Publication: England NLM ID: 101669491 Publication Model: Print Cited Medium: Internet ISSN: 2055-6845 (Electronic) NLM ISO Abbreviation: Eur Heart J Cardiovasc Pharmacother Subsets: MEDLINE
    • Publication Information:
      Original Publication: Oxford : Oxford University Press, [2015]-
    • Subject Terms:
      Diabetes Mellitus, Type 2*/complications ; Diabetes Mellitus, Type 2*/diagnosis ; Diabetes Mellitus, Type 2*/drug therapy ; Dipeptidyl-Peptidase IV Inhibitors*/adverse effects ; Sodium-Glucose Transporter 2 Inhibitors*/adverse effects ; Hyperkalemia*/chemically induced ; Hypokalemia*/chemically induced ; Hypokalemia*/diagnosis ; Hypokalemia*/epidemiology; Humans ; Male ; Middle Aged ; Aged ; Female ; Sodium-Glucose Transporter 2 ; Hypoglycemic Agents/adverse effects ; Potassium
    • Abstract:
      Aims: To investigate the risk of hyperkalaemia in new users of sodium-glucose cotransporter 2 (SGLT2) inhibitors vs. dipeptidyl peptidase-4 (DPP-4) inhibitors among patients with type 2 diabetes mellitus (T2DM).
      Methods and Results: Patients with T2DM who commenced treatment with an SGLT2 or a DPP-4 inhibitor between 2015 and 2019 were collected. A multivariable Cox proportional hazards analysis was applied to compare the risk of central laboratory-determined severe hyperkalaemia, hyperkalaemia, hypokalaemia (serum potassium ≥6.0, ≥5.5, and <3.5 mmol/L, respectively), and initiation of a potassium binder in patients newly prescribed an SGLT2 or a DPP-4 inhibitor. A total of 28 599 patients (mean age 60 ± 11 years, 60.9% male) were included after 1:2 propensity score matching, of whom 10 586 were new users of SGLT2 inhibitors and 18 013 of DPP-4 inhibitors. During a 2-year follow-up, severe hyperkalaemia developed in 122 SGLT2 inhibitor users and 325 DPP-4 inhibitor users. Use of SGLT2 inhibitors was associated with a 29% reduction in incident severe hyperkalaemia [hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.58-0.88] compared with DPP-4 inhibitors. Risk of hyperkalaemia (HR 0.81, 95% CI 0.71-0.92) and prescription of a potassium binder (HR 0.74, 95% CI 0.67-0.82) were likewise decreased with SGLT2 inhibitors compared with DPP-4 inhibitors. Occurrence of incident hypokalaemia was nonetheless similar between those prescribed an SGLT2 inhibitor and those prescribed a DPP-4 inhibitor (HR 0.90, 95% CI 0.81-1.01).
      Conclusion: Our study provides real-world evidence that compared with DPP-4 inhibitors, SGLT2 inhibitors were associated with lower risk of hyperkalaemia and did not increase the incidence of hypokalaemia in patients with T2DM.
      (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
    • Grant Information:
      501100001809 Sanming Project of Medicine in Shenzhen; SZXK2020081 HKU-SZH Fund for Shenzhen Key Medical Discipline
    • Contributed Indexing:
      Keywords: DPP-4 inhibitors; Hyperkalaemia; SGLT2 inhibitors; Type 2 diabetes mellitus
    • Accession Number:
      0 (Dipeptidyl-Peptidase IV Inhibitors)
      0 (Sodium-Glucose Transporter 2 Inhibitors)
      0 (Sodium-Glucose Transporter 2)
      0 (Hypoglycemic Agents)
      RWP5GA015D (Potassium)
    • Publication Date:
      Date Created: 20231109 Date Completed: 20240108 Latest Revision: 20240108
    • Publication Date:
      20240108
    • Accession Number:
      10.1093/ehjcvp/pvad081
    • Accession Number:
      37942588