Comparative effectiveness of sodium-glucose cotransporter-2 inhibitors versus glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes and mild/moderate chronic kidney disease.

Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 100883645 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1463-1326 (Electronic) Linking ISSN: 14628902 NLM ISO Abbreviation: Diabetes Obes Metab Subsets: MEDLINE

Original Publication: Oxford : Wiley-Blackwell, c1999-

Cardiovascular Diseases*/chemically induced ; Diabetes Mellitus, Type 2*/complications ; Diabetes Mellitus, Type 2*/drug therapy ; Diabetes Mellitus, Type 2*/chemically induced ; Dipeptidyl-Peptidase IV Inhibitors*/adverse effects ; Myocardial Infarction*/chemically induced ; Renal Insufficiency, Chronic*/complications ; Renal Insufficiency, Chronic*/drug therapy ; Renal Insufficiency, Chronic*/epidemiology ; Sodium-Glucose Transporter 2 Inhibitors*/therapeutic use ; Stroke*/epidemiology ; Stroke*/etiology ; Stroke*/prevention & control; Humans ; Albumins ; Creatinine ; Glucagon-Like Peptide-1 Receptor/agonists ; Glucagon-Like Peptide-1 Receptor Agonists ; Glucose ; Hypoglycemic Agents/therapeutic use ; Sodium ; United States/epidemiology

Aim: To determine the comparative effectiveness regarding major cardiovascular events of glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD).
Materials and Methods: We assembled a cohort of commercially insured adult patients with T2DM in the United States (derived from Optum Clinformatics DataMart 2003-2021) who were new users of GLP-1 receptor agonists or SGLT-2 inhibitors. We compared risks of non-fatal myocardial infarction or stroke in patients with and without CKD, and further categorized by CKD stage: stages G1 or G2 [estimated glomerular filtration rate (eGFR) ≥60 ml/min] and A2 (urine albumin to creatinine ratio 30 to <300 mg/g) or A3 (urine albumin to creatinine ratio ≥300 mg/g), stage G3a (eGFR 45 to <60 ml/min/1.73 m ² ) and stage G3b (eGFR 30 to <45 ml/min/1.73 m ² ). We used proportional hazards regression after inverse probability of treatment weighting to compute hazard ratios and 95% confidence intervals.
Results: After accounting for the probability of treatment, patients with T2DM and CKD treated with SGLT-2 inhibitors experienced a 14% lower risk of non-fatal myocardial infarction or stroke (hazard ratio 0.86, 95% confidence interval 0.78-0.94) relative to those treated with GLP-1 receptor agonists.
Conclusions: Recognizing the potential for residual confounding, selection bias and immortal time bias, commercially insured patients in the United States with T2DM and CKD treated with SGLT-2 inhibitors experienced significantly lower risks of non-fatal myocardial infarction or stroke relative to those treated with GLP-1 receptor agonists.
(© 2024 John Wiley & Sons Ltd.)

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K01 DK110221 United States DK NIDDK NIH HHS; K24 DK085446 United States DK NIDDK NIH HHS; K24DK085446 United States DK NIDDK NIH HHS; 5K01DK110221 United States DK NIDDK NIH HHS

Keywords: GLP-1; SGLT-2 inhibitor; antidiabetic drug; cardiovascular disease; pharmacoepidemiology; real-world evidence

0 (Albumins)
AYI8EX34EU (Creatinine)
0 (Dipeptidyl-Peptidase IV Inhibitors)
0 (Glucagon-Like Peptide-1 Receptor)
0 (Glucagon-Like Peptide-1 Receptor Agonists)
IY9XDZ35W2 (Glucose)
0 (Hypoglycemic Agents)
9NEZ333N27 (Sodium)
0 (Sodium-Glucose Transporter 2 Inhibitors)

Date Created: 20240108 Date Completed: 20240305 Latest Revision: 20240314

20240314

PMC10932840

10.1111/dom.15427

38186297