Department of Information Engineering, Università degli Studi di Padova, Padova, Veneto, Italy.
Azienda Zero, Regione Veneto, Padova, Veneto, Italy.
BMJ Open Diabetes Res Care. 2020 Jun;8(1). doi: 10.1136/bmjdrc-2020-001451.
Sodium glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) protect type 2 diabetic (T2D) patients from cardiovascular events, but no trial has directly compared their cardiovascular effects. We aimed to address this gap using real-world data.
We performed a retrospective real-world study on a population of ~5 million inhabitants from North-East Italy. We identified T2D patients who received new prescription of SGLT2i or GLP-1RA from 2014 to 2018. SGLT2i and GLP-1RA initiators were matched 1:1 by propensity scores. The primary outcome was a composite of all-cause death, myocardial infarction, and stroke (three-point major adverse cardiovascular events (3P-MACE)). Secondary endpoints were each component of the primary endpoint, hospitalization for heart failure (HF), revascularization, hospitalization for cardiovascular causes, and adverse events.
From a population of 330 193 diabetic patients, we followed 8596 SGLT2i and GLP-1RA matched initiators for a median of 13 months. Patients in both groups were on average 63 years old, 63% men, and 18% had pre-existing cardiovascular disease. T2D patients treated with SGLT2i versus GLP-1RA, experienced a lower rate of 3P-MACE (HR 0.68; 95% CI 0.61 to 0.99; p=0.043), myocardial infarction (HR 0.72; 95% CI 0.53 to 0.98; p=0.035), hospitalization for HF (HR 0.59; 95% CI 0.35 to 0.99; p=0.048), and hospitalization for cardiovascular causes (HR 0.82; 95% CI 0.69 to 0.99; p=0.037). Adverse events were not significantly different between the two groups.
In the absence of dedicated trials, this observational study suggests that SGLT2i may be more effective than GLP-1RA in improving cardiovascular outcomes of T2D.
NCT04184947.
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）和胰高血糖素样肽-1 受体激动剂（GLP-1RA）可预防 2 型糖尿病（T2D）患者发生心血管事件，但尚无试验直接比较其心血管效应。我们旨在利用真实世界的数据来解决这一空白。
我们对意大利东北部约 500 万居民进行了一项回顾性真实世界研究。我们确定了 2014 年至 2018 年间接受 SGLT2i 或 GLP-1RA 新处方的 T2D 患者。通过倾向评分对 SGLT2i 和 GLP-1RA 起始者进行 1:1 匹配。主要结局为全因死亡、心肌梗死和卒中（三点主要不良心血管事件（3P-MACE））的复合结局。次要终点为主要结局的各个组成部分、心力衰竭（HF）住院、血运重建、心血管原因住院和不良事件。
从 330193 名糖尿病患者中，我们随访了 8596 名 SGLT2i 和 GLP-1RA 匹配的起始者，中位随访时间为 13 个月。两组患者的平均年龄为 63 岁，63%为男性，18%有既往心血管疾病。与接受 GLP-1RA 治疗的患者相比，接受 SGLT2i 治疗的 T2D 患者 3P-MACE（HR 0.68；95%CI 0.61 至 0.99；p=0.043）、心肌梗死（HR 0.72；95%CI 0.53 至 0.98；p=0.035）、HF 住院（HR 0.59；95%CI 0.35 至 0.99；p=0.048）和心血管原因住院（HR 0.82；95%CI 0.69 至 0.99；p=0.037）的发生率较低。两组的不良事件无显著差异。
在缺乏专门试验的情况下，这项观察性研究表明，SGLT2i 可能比 GLP-1RA 更能改善 T2D 的心血管结局。
NCT04184947。
