GLP1 Receptor Agonists reduce VTE risk in Type 2 Diabetes, claims research

Glucagon-like peptide 1 receptor agonists (GLP1-RA) are antihyperglycemic agents used for the treatment of type 2 diabetes mellitus (T2DM) which is a global pandemic. They are also prescribed for weight loss in obese patients. Research shows a consistent cardiovascular benefit with the use of GLP1-RA in T2DM. Previous studies have shown that GLP1-RA may reduce the thromboxane-induced platelet activation. As obesity is one of the risk factors for venous thromboembolism (VTE) researchers hypothesized that GLP1-RA use may reduce the risk of VTE.

A retrospective, propensity score-matched multicenter database analysis was carried out using the TriNetX Analytics Network. Individuals with T2DM were taken for the study as diabetics use GLP1-RA. Individuals using oral anticoagulation, prior VTE, or a history of atrial fibrillation were excluded from the study.

Comparisons were done between patients who received GLP1-RA with those who received Dipeptidyl Peptidase-4 (DPP-4) inhibitors for achieving glycemic control. A subgroup analysis was also performed stratified by the presence of obesity. An individual was considered obese if they have a body mass index (BMI) 30 kg/m². The primary outcome was incidence rate per 1000-patient years of all VTE at 1-year after the index date of first initiation of GLP1-RA or DPP-4 inhibitors. pulmonary embolism (PE) and deep venous thrombosis (DVT) measured individually were the secondary outcomes.

propensity-matching was done to patients (1:1) taking GLP1-RA with those on DPP-4 inhibitors based on predetermined clinical variables, including age, sex, race, BMI, hemoglobin A1c, use of other anti-diabetic agents including metformin and insulin, and underlying comorbidities. Charleston Comorbidity index was used for the propensity matching. a subgroup analysis was carried out as a secondary analysis stratified by the presence of obesity.

Findings:

• About 6,56,588 eligible patients who had T2DM were identified of whom 366,369 received GLP1-RA and 290,219 received DPP-4 inhibitors, respectively.
• Among patients with known BMI data, 62% of the patients were classified as obese with a BMI of 30kg/m².
• Two cohorts ach having 168,428 patients were included in the final analysis who received GLP1-RA and DPP-4 inhibitors after propensity-score matching.
• Both cohorts were well balanced for demographics, hemoglobin A1c, BMI, other anti-diabetic drugs, and preexisting comorbidities.
• The mean HbA1c were 8.3 ± 2.0 and 8.3 ± 2.0, and the mean BMI was 33.3 ± 7.4 and 32.4 ± 7.1 for patients on GLP1-RA and DPP-4 inhibitors, respectively.
• The incidence of VTE was 11.0 events per 1000 patient-years in the GLP1-RA cohort vs. 12.9 in the DPP-4 inhibitor cohort indicating that GLP1-RA decreased the VTE.
• Patients who received GLP1-RA had an 18% lower risk of VTE than those who received DPP-4 inhibitors.
• Similarly, patients who received GLP1-RA had a lower risk of PE and DVT than those on DPP-4 inhibitors.
• In the subgroup analysis, similar differences in VTE rates were observed in patients with obesity and without obesity.

Thus, the study concluded that GLP1-RA reduces the risk of VTE and has a potential beyond glycemic control in individuals with obesity and type 2 diabetes.

Further reading:

Glucagon-like Peptide 1 Receptor Agonists Reduce the Risk of Venous Thromboembolism in Patients with Diabetes Irrespective of Obesity: A Propensity Score-Matched Multicenter Database Analysis. Oral and Poster Abstracts. Poster No.701.