Department of Endocrinology & Metabolism, Ajou University School of Medicine, Suwon, South Korea.
Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, South Korea.
Diabetes Obes Metab. 2021 Mar;23(3):682-691. doi: 10.1111/dom.14261. Epub 2020 Dec 15.
To examine the real-world cardiovascular effectiveness and safety associated with sodium-glucose co-transporter-2 (SGLT2) inhibitor compared with dipeptidyl peptidase-4 (DPP-4) inhibitor treatment in older adults with type 2 diabetes.
In this retrospective cohort study, older adults with type 2 diabetes (aged ≥65 years) were identified in the Korean National Health Insurance Service database from September 2014 to December 2016. In total, 408 506 new users of an SGLT2 inhibitor or DPP-4 inhibitor were propensity score matched. Cox regression was used to estimate the hazard ratios (HR) and 95% confidence interval (CI) for outcomes of interest: hospitalization for heart failure (HHF), all-cause death, myocardial infarction, stroke, diabetic ketoacidosis (DKA), bone fracture, severe hypoglycaemia, genital infection and urinary tract infection (UTI).
Compared with DPP-4 inhibitors, new users of SGLT2 inhibitors had a lower risk of HHF (HR 0.86; 95% CI 0.76-0.97), all-cause death (HR 0.85; 95% CI 0.75-0.98) and stroke (HR 0.86; 95% CI 0.77-0.97), but a similar risk of myocardial infarction (HR 0.95; 95% CI 0.77-1.19). The risks of DKA, bone fracture and severe hypoglycaemia were similar between both groups, although genital infection (HR 2.44; 95% CI 2.22-2.67) and UTI (HR 1.05; 95% CI 1.00-21.11) were more frequent among new users of SGLT2 inhibitors compared with DPP-4 inhibitors.
Our findings suggest that initiation of SGLT2 inhibitors offers cardiovascular disease protection and can be used safely in older adults with type 2 diabetes.
研究与二肽基肽酶-4（DPP-4）抑制剂相比，钠-葡萄糖协同转运蛋白 2（SGLT2）抑制剂在老年 2 型糖尿病患者中的真实世界心血管有效性和安全性。
在这项回顾性队列研究中，我们从 2014 年 9 月至 2016 年 12 月在韩国国家健康保险服务数据库中确定了年龄≥65 岁的 2 型糖尿病新患者。总共对 408506 例 SGLT2 抑制剂或 DPP-4 抑制剂的新使用者进行了倾向评分匹配。使用 Cox 回归估计了以下结果的风险比（HR）和 95%置信区间（CI）：心力衰竭（HFH）住院、全因死亡、心肌梗死、中风、糖尿病酮症酸中毒（DKA）、骨折、严重低血糖、生殖器感染和尿路感染（UTI）。
与 DPP-4 抑制剂相比，SGLT2 抑制剂的新使用者 HFH（HR 0.86；95%CI 0.76-0.97）、全因死亡（HR 0.85；95%CI 0.75-0.98）和中风（HR 0.86；95%CI 0.77-0.97）的风险较低，但心肌梗死（HR 0.95；95%CI 0.77-1.19）的风险相似。两组 DKA、骨折和严重低血糖的风险相似，但 SGLT2 抑制剂新使用者的生殖器感染（HR 2.44；95%CI 2.22-2.67）和 UTI（HR 1.05；95%CI 1.00-21.11）的风险高于 DPP-4 抑制剂。
我们的研究结果表明，SGLT2 抑制剂的起始可提供心血管疾病保护作用，可安全用于老年 2 型糖尿病患者。
