SGLT2 inhibitors better than sulfonylureas for reducing deaths in type 2 diabetes: JAMA
St Louis, Missouri: The use of SGLT2 inhibitors may reduce the risk of all-cause mortality compared with sulfonylureas in patients with type 2 diabetes receiving metformin therapy, finds a recent study in JAMA Internal Medicine. This reduced risk was independent of cardiovascular disease status, estimated glomerular filtration rate category, and albuminuria status.
"The results provide data from real-world settings that may help guide the choice of antihyperglycemic therapy in type 2 diabetes patients," wrote the authors.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new class of antihyperglycemics that reduces the risk of adverse cardiovascular and kidney events. Studies have also shown SGLT2 inhibitors to be beneficial even in people without diabetes. There is a lack of evidence of the comparative effectiveness of SGLT2 inhibitors verus sulfonylureas—the second most widely used antihyperglycemic class after metformin
Against the above background, Yan Xie, VA St Louis Health Care System, St Louis, Missouri, and colleagues aimed to evaluate the comparative effectiveness of SGLT2 inhibitors and sulfonylureas associated with the risk of all-cause mortality among patients with type 2 diabetes using metformin.
For this purpose, the researchers conducted a cohort study comparing the use of SGLT2 inhibitors vs sulfonylureas in individuals receiving metformin for treatment of type 2 diabetes using data from the US Department of Veterans Affairs. The study enrolled a total of 23 870 people with the new use of SGLT2 inhibitors and 104 423 individuals with new use of sulfonylureas between October 1, 2016, and February 29, 2020.
Key findings of the study include:
- Compared with sulfonylureas, SGLT2 inhibitors were associated with reduced risk of all-cause mortality (hazard ratio [HR], 0.81), yielding an event rate difference of −5.15 deaths per 1000 person-years.
- Compared with sulfonylureas, SGLT2 inhibitors were associated with a reduced risk of death, regardless of cardiovascular disease status, in several categories of estimated glomerular filtration rate (including rates from >90 to ≤30 mL/min/1.73 m2) and in participants with no albuminuria (albumin to creatinine ratio [ACR] ≤30 mg/g), microalbuminuria (ACR >30 to ≤300 mg/g), and macroalbuminuria (ACR >300 mg/g).
- In per-protocol analyses, continued use of SGLT2 inhibitors was associated with a reduced risk of death compared with continued use of sulfonylureas (HR, 0.66; event rate difference, −10.10; −12.97 to −7.24 deaths per 1000 person-years).
- In additional per-protocol analyses, continued use of SGLT2 inhibitors with metformin was associated with a reduced risk of death compared with SGLT2 inhibitor treatment without metformin (HR, 0.70; event rate difference, −7.62; −17.12 to −0.48 deaths per 1000 person-years).
"Our findings show that SGLT2 inhibitor treatment was associated with a reduced risk of all-cause mortality compared with sulfonylureas. The results provide data from a real-world setting that might help guide the choice of antihyperglycemic therapy," the team concluded.
Reference:
The study titled, "Comparative Effectiveness of Sodium-Glucose Cotransporter 2 Inhibitors vs Sulfonylureas in Patients With Type 2 Diabetes," is published in JAMA Internal Medicine.
DOI: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2781475
