Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Diabetes Care. 2021 Mar;44(3):826-835. doi: 10.2337/dc20-1464. Epub 2021 Jan 25.
Both sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) demonstrated cardiovascular benefits in randomized controlled trials of patients with type 2 diabetes (T2D) generally <65 years old and mostly with cardiovascular disease. We aimed to evaluate the comparative effectiveness and safety of SGLT2i and GLP-1RA among real-world older adults.
Using Medicare data (April 2013-December 2016), we identified 90,094 propensity score-matched (1:1) T2D patients ≥66 years old initiating SGLT2i or GLP-1RA. Primary outcomes were major adverse cardiovascular events (MACE) (i.e., myocardial infarction, stroke, or cardiovascular death) and hospitalization for heart failure (HHF). Other outcomes included diabetic ketoacidosis (DKA), genital infections, fractures, lower-limb amputations (LLA), acute kidney injury (AKI), severe urinary tract infections, and overall mortality. We estimated hazard ratios (HRs) and rate differences (RDs) per 1,000 person-years, controlling for 140 baseline covariates.
Compared with GLP-1RA, SGLT2i initiators had similar MACE risk (HR 0.98 [95% CI 0.87, 1.10]; RD -0.38 [95% CI -2.48, 1.72]) and reduced HHF risk (HR 0.68 [95% CI 0.57, 0.80]; RD -3.23 [95% CI -4.68, -1.77]), over a median follow-up of ∼6 months. They also had 0.7 more DKA events (RD 0.72 [95% CI 0.02, 1.41]), 0.9 more LLA (RD 0.90 [95% CI 0.10, 1.70]), 57.1 more genital infections (RD 57.08 [95% CI 53.45, 60.70]), and 7.1 fewer AKI events (RD -7.05 [95% CI -10.27, -3.83]) per 1,000 person-years.
Among older adults, those taking SGLT2i had similar MACE risk, decreased HHF risk, and increased risk of DKA, LLA, and genital infections versus those taking GLP-1RA.
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）在一般年龄<65 岁且大多患有心血管疾病的 2 型糖尿病（T2D）患者的随机对照试验中均显示出心血管获益。我们旨在评估 SGLT2i 和 GLP-1RA 在真实世界老年人群中的比较有效性和安全性。
利用医疗保险数据（2013 年 4 月至 2016 年 12 月），我们确定了 90,094 名年龄≥66 岁、起始使用 SGLT2i 或 GLP-1RA 的倾向评分匹配（1:1）的 T2D 患者。主要结局为主要不良心血管事件（MACE）（即心肌梗死、中风或心血管死亡）和心力衰竭住院（HHF）。其他结局包括糖尿病酮症酸中毒（DKA）、生殖器感染、骨折、下肢截肢（LLA）、急性肾损伤（AKI）、严重尿路感染和全因死亡率。我们估计了每 1000 人年的风险比（HR）和率差（RD），并控制了 140 个基线协变量。
与 GLP-1RA 相比，SGLT2i 起始治疗者的 MACE 风险相似（HR 0.98 [95% CI 0.87, 1.10]；RD -0.38 [95% CI -2.48, 1.72]），HHF 风险降低（HR 0.68 [95% CI 0.57, 0.80]；RD -3.23 [95% CI -4.68, -1.77]），中位随访时间约为 6 个月。SGLT2i 起始治疗者的 DKA 事件多 0.7 例（RD 0.72 [95% CI 0.02, 1.41]），LLA 多 0.9 例（RD 0.90 [95% CI 0.10, 1.70]），生殖器感染多 57.08 例（RD 57.08 [95% CI 53.45, 60.70]），AKI 事件少 7.1 例（RD -7.05 [95% CI -10.27, -3.83]）。
在老年人群中，与 GLP-1RA 相比，使用 SGLT2i 的患者 MACE 风险相似，HHF 风险降低，而 DKA、LLA 和生殖器感染的风险增加。
