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Type 2 diabetes: SGLT2 inhibitors not tied to fracture risk in older adults, finds study
![Type 2 diabetes: SGLT2 inhibitors not tied to fracture risk in older adults, finds study Type 2 diabetes: SGLT2 inhibitors not tied to fracture risk in older adults, finds study](https://medicaldialogues.in/h-upload/2020/08/21/750x450_133374-sglt2-inhibitors.webp)
Boston, MA: A recent study in the JAMA Network Open has shown that the initiation of SGLT2 inhibitors does not appear to increase the risk of fracture in older adults with type 2 diabetes versus other diabetes agents.
Older adults with type 2 diabetes (T2D) are known to be at a higher risk of death from cardiovascular disease compared to their peers without T2D. Sodium-glucose cotransporter–2 inhibitors (SGLT-2i) are oral diabetes medications that reduce the risk of end-stage kidney disease, atherosclerotic cardiovascular events, hospitalization for heart failure, and death among adults with T2D. However, results from previous studies have shown SGLT-2i to be associated with increased fracture risk.
Based on the above background, Min Zhuo, Harvard Medical School, Boston, Massachusetts, and colleagues aimed to examine the association of incident fracture among older adults with T2D with initiating an SGLT-2i compared with initiating a dipeptidyl peptidase 4 inhibitor (DPP-4i) or a glucagon-like peptide 1 receptor agonist (GLP-1RA).
For this purpose, the researchers performed a population-based, new-user cohort study including older adults with T2D enrolled in Medicare fee-for-service from April 2013 to December 2017. New users of an SGLT-2i, DPP-4i, or GLP-1RA without a previous fracture were matched in a 1:1:1 ratio using 3-way propensity score matching.
Of 466 933 new initiators of study drugs, 62 454 patients were new SGLT-2i users. After 3-way matching, 45 889 (73%) new SGLT-2i users were matched to new users of DPP-4i and GLP-1RA, yielding a cohort of 137 667 patients (mean age, 72 years; 64 126 men [47%]) matched 1:1:1 for analyses.
Based on the study, the researchers found no difference in the risk of fracture in SGLT-2i users compared with DPP-4i users (HR, 0.90) or GLP-1RA users (HR, 1.00). These results were found to be consistent across categories of sex, frailty (non-frail, prefrail, and frail), age (<75 and ≥75 years), and insulin use (baseline users and nonusers).
"In this nationwide Medicare cohort, initiating an SGLT-2i was not associated with an increased risk of fracture in older adults with T2D compared with initiating a DPP-4i or GLP-1RA, with consistent results across categories of frailty, age, and insulin use," the researchers wrote. "These findings add to the evidence base evaluating the potential risks associated with SGLT-2i use for older adults outside of randomized clinical trials."
Reference:
Zhuo M, Hawley CE, Paik JM, et al. Association of Sodium-Glucose Cotransporter–2 Inhibitors With Fracture Risk in Older Adults With Type 2 Diabetes. JAMA Netw Open. 2021;4(10):e2130762. doi:10.1001/jamanetworkopen.2021.30762
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: editorial@medicaldialogues.in. Contact no. 011-43720751