SGLT-2 inhibitors better than DPP-4 inhibitors in frail diabetes patients

Australia: Sodium-glucose cotransporter-2 inhibitors may be preferred to dipeptidyl peptidase-4 inhibitors for reducing rates of major adverse cardiovascular events, heart failure hospitalizations, and all-cause mortality in frail people with type 2 diabetes, states an article published in the Frontiers in Pharmacology.

FDA-approved Sodium-glucose cotransporter-2 inhibitors (SGLT-2Is) are prescribed to lower blood sugar in adults with type 2 diabetes. Studies have shown that SGLT2 inhibitors are also beneficial in reducing heart failure (HF) hospitalizations and major adverse cardiovascular events (MACE) in general type 2 diabetes populations. However, those with frailty are typically excluded from the studies despite their high prevalence of diabetes. There is increasing interest in whether treatment benefits and risks in general older populations can be extended to frail people.

Frailty is a medical condition closely related to diabetes and a risk factor for diabetes-related complications. Frail people have over 5-times higher odds of hospitalization and a 35% increased risk of mortality compared to non-frail individuals with diabetes. SGLT-2Is and dipeptidyl peptidase-4 inhibitors may be preferred over sulfonylureas and insulin in people at high risk of hypoglycemia such as those who are frail. It remains unclear whether SGLT-2Is or DPP-4Is have the same benefits and risks in frail people with type 2 diabetes compared to non-frail people with type 2 diabetes.

Wood S, Monash University, Australia and colleagues conducted a study to determine whether SGLT-2Is vs. dipeptidyl peptidase-4 inhibitors (DPP-4Is) are associated with reductions in MACE, HF hospitalizations, and mortality in frail people with type 2 diabetes.

Researchers included 32,043 patients, (aged ≥30 years) with type 2 diabetes discharged from a hospital in the cohort. They received SGLT-2Is or DPP-4Is within 60 days of discharge. Follow-up commenced 60 days after initial discharge, and MACE, HF hospitalization, and mortality were recorded. Analyses were stratified into frailty quartiles according to Hospital Frailty Risk Scores(HFRSs). Cox proportional hazards regression with competing risks and stabilized inverse probability of treatment weights (IPTWs), was used to generate subdistribution hazard ratios (sHRs)

Key findings of the study,

• Overall, SGLT-2I versus DPP-4I recipients had lower rates of MACE (sHR 0.51), HF hospitalization (sHR 0.42), and mortality (HR 0.38).

• People with HFRSs in the fourth quartile who received SGLT-2Is versus DPP-4Is also had reduced rates of MACE (sHR 0.37), HF hospitalization (sHR 0.43), and mortality (HR 0.32).

The authors conclude that study provides preliminary evidence to suggest that SGLT-2Is may be preferred to DPP-4Is in the treatment of frail people living with type 2 diabetes as it showed a reduced rate of MACE, HF hospitalizations, and all-cause mortality. These findings may help the development of updated type 2 diabetes clinical practice guidelines.

Reference:

Wood SJ, Bell JS, Magliano DJ, Shaw JE, Cesari M, Ilomaki J. Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors vs. Dipeptidyl Peptidase-4 Inhibitors in Frail People With Diabetes Who Were Recently Hospitalized. Front Pharmacol. 2022 Jul 12;13:886834. doi: 10.3389/fphar.2022.886834.