Institute of Medicine, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Cardiovasc Diabetol. 2021 Mar 22;20(1):67. doi: 10.1186/s12933-021-01258-x.
Major prospective randomized clinical safety trials have demonstrated beneficial effects of treatment with glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose co-transporter-2 inhibitors (SGLT-2i) in people with type 2 diabetes and elevated cardiovascular risk, and recent clinical treatment guidelines therefore promote early use of these classes of pharmacological agents. In this Swedish nationwide observational study, we compared cardiorenal outcomes and safety of new treatment with GLP-1RA and SGLT-2i in people with type 2 diabetes.
We linked data from national Swedish databases to capture patient characteristics and outcomes and used propensity-score based matching to account for differences between the two groups. The treatments were compared using Cox regression models.
We identified 9648 participants starting GLP-1RA and 12,097 starting SGLT-2i with median follow-up times 1.7 and 1.1 years, respectively. The proportion of patients with a history of MACE were 15.8%, and 17.0% in patients treated with GLP-1RA and SGLT-2i, respectively. The mean age was 61 years with 7.6 years duration of diabetes. Mean HbA1c were 8.3% (67.6 mmol/mol) and 8.3% (67.2 mmol/mol), and mean BMI 33.3 and 32.5 kg/m in patients treated with GLP-1RA or SGLT-2i, respectively. The cumulative mortality risk was non-significantly lower in the group treated with SGLT-2i, HR 0.78 (95% CI 0.61-1.01), as were incident heart failure outcomes, but the risks of cardiovascular or renal outcomes did not differ. The risks of stroke and peripheral artery disease were higher in the SGLT-2i group relative to GLP-1RA, with HR 1.44 (95% CI 0.99-2.08) and 1.68 (95% CI 1.04-2.72), respectively.
This observational study suggests that treatment with GLP-1RA and SGLT-2i result in very similar cardiorenal outcomes. In the short term, treatment with GLP-1RA seem to be associated with lower risks of stroke and peripheral artery disease, whereas SGLT-2i seem to be nominally associated with lower risk of heart failure and total mortality.
大型前瞻性随机临床安全性试验表明，胰高血糖素样肽-1 受体激动剂（GLP-1RA）和钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2i）治疗 2 型糖尿病和心血管风险升高的患者具有有益效果，最近的临床治疗指南因此提倡早期使用这些类别的药物。在这项瑞典全国性观察性研究中，我们比较了 2 型糖尿病患者使用 GLP-1RA 和 SGLT-2i 的心脏肾结局和安全性。
我们将国家瑞典数据库的数据进行链接，以捕获患者特征和结局，并使用倾向评分匹配来解释两组之间的差异。使用 Cox 回归模型比较治疗方法。
我们确定了 9648 名开始使用 GLP-1RA 和 12097 名开始使用 SGLT-2i 的患者，中位随访时间分别为 1.7 年和 1.1 年。有既往 MACE 病史的患者比例分别为 15.8%和 17.0%，分别接受 GLP-1RA 和 SGLT-2i 治疗。平均年龄为 61 岁，糖尿病病程为 7.6 年。GLP-1RA 和 SGLT-2i 治疗组的平均 HbA1c 分别为 8.3%（67.6mmol/mol）和 8.3%（67.2mmol/mol），平均 BMI 分别为 33.3 和 32.5kg/m。SGLT-2i 治疗组的累积死亡率风险显著降低，HR 为 0.78（95%CI 0.61-1.01），心力衰竭事件的发生率也降低，但心血管或肾脏结局的风险没有差异。与 GLP-1RA 相比，SGLT-2i 组的中风和外周动脉疾病风险更高，HR 分别为 1.44（95%CI 0.99-2.08）和 1.68（95%CI 1.04-2.72）。
这项观察性研究表明，GLP-1RA 和 SGLT-2i 的治疗结果非常相似。短期内，GLP-1RA 治疗似乎与中风和外周动脉疾病风险降低相关，而 SGLT-2i 治疗则与心力衰竭和总死亡率降低相关。
