Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK.
Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Diabetes Obes Metab. 2021 Oct;23(10):2207-2214. doi: 10.1111/dom.14437. Epub 2021 Aug 2.
To assess if sodium-glucose co-transporter-2 inhibitors (SGLT2is) reduce the risk of all-cause mortality, cardiovascular death and hospitalization for heart failure (HF) or chronic kidney disease (CKD) to a greater extent than dipeptidyl peptidase-4 inhibitors (DPP4is) in people with type 2 diabetes (T2D) with or without established cardiovascular and/or renal disease (CVRD).
This retrospective cohort study propensity-matched 24 438 patients receiving an SGLT2i 1:1 to a patient receiving a DDP4i, stratified based on the presence of CVRD. The primary outcomes were the time to each of the following: all-cause mortality, cardiovascular death or hospitalization for HF, myocardial infarction, stroke and CKD.
Overall, SGLT2is were associated with reductions in all-cause mortality, cardiovascular mortality, hospitalization for HF and hospitalization for CKD compared with DPP4is. In patients with no CVRD history, SGLT2is were associated with reductions in all-cause mortality (HR 0.71, 95% CI 0.57-0.88; P = .002), hospitalization for HF (HR 0.76, 95% CI 0.59-0.98; P = .035) and hospitalization for CKD (HR 0.75, 95% CI 0.63-0.88; P < .001). In patients with established cardiovascular disease (CVD) or at high risk, SGLT2is were associated with reductions in all-cause mortality (HR 0.69, 95% CI 0.59-0.82; P < .001), cardiovascular mortality (HR 0.76, 95% CI 0.62-0.95; P = .014), hospitalization for HF (HR 0.73, 95% CI 0.63-0.85; P < .001), hospitalization for stroke (HR 0.75, 95% CI 0.59-0.94; P = .013) and hospitalization for CKD (HR 0.49, 95% CI 0.43-0.54; P < .001).
There was consistency across subgroups and sensitivity analyses. SGLT2is were associated with a reduced risk of all-cause mortality and hospitalization for HF and CKD compared with DPP4-is, highlighting the need to introduce SGLT2is early in the management of patients with T2D.
评估钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）是否比二肽基肽酶 4 抑制剂（DPP4i）更能降低 2 型糖尿病（T2D）患者（无论是否有已确诊的心血管疾病和/或肾脏疾病（CVRD））全因死亡率、心血管死亡和因心力衰竭（HF）或慢性肾病（CKD）住院的风险。
本回顾性队列研究对接受 SGLT2i 的 24438 例患者与接受 DPP4i 的患者进行了 1:1 的倾向评分匹配，按是否存在 CVRD 进行分层。主要结局为以下各项的时间：全因死亡率、心血管死亡率、HF 住院、心肌梗死、卒中和 CKD 住院。
总体而言，与 DPP4i 相比，SGLT2i 可降低全因死亡率、心血管死亡率、HF 住院和 CKD 住院风险。在无 CVRD 病史的患者中，SGLT2i 可降低全因死亡率（HR 0.71，95%CI 0.57-0.88；P=0.002）、HF 住院率（HR 0.76，95%CI 0.59-0.98；P=0.035）和 CKD 住院率（HR 0.75，95%CI 0.63-0.88；P<0.001）。在已确诊心血管疾病（CVD）或高危患者中，SGLT2i 可降低全因死亡率（HR 0.69，95%CI 0.59-0.82；P<0.001）、心血管死亡率（HR 0.76，95%CI 0.62-0.95；P=0.014）、HF 住院率（HR 0.73，95%CI 0.63-0.85；P<0.001）、卒中住院率（HR 0.75，95%CI 0.59-0.94；P=0.013）和 CKD 住院率（HR 0.49，95%CI 0.43-0.54；P<0.001）。
各亚组和敏感性分析结果一致。与 DPP4i 相比，SGLT2i 可降低全因死亡率和 HF 及 CKD 住院风险，这突出表明需要在 T2D 患者的治疗中尽早引入 SGLT2i。
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