Goh Louise Gek Huang, Sun Jiandong, Ong Benjamin Shao Kiat, Khoo Daphne, Sum Chee Fang, Ng Kwong
Agency for Care Effectiveness (ACE), Ministry of Health, 16 College Road, College of Medicine Building, Singapore, 169854 Singapore.
Diabetes Centre, Admiralty Medical Centre and Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828 Singapore.
J Diabetes Metab Disord. 2022 Mar 3;21(1):521-555. doi: 10.1007/s40200-022-01004-4. eCollection 2022 Jun.
Sodium-glucose co-transporter-2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP4) inhibitors are increasingly used as second-line therapies in patients with type 2 diabetes. The aim of this study was to assess the real-world effects of SGLT2 inhibitors in a multi-ethnic population in Singapore.
This retrospective cohort study examined patients diagnosed with and treated for diabetes from the Ministry of Health's administrative database. Differences in outcomes between treatment groups were assessed using Poisson regression. Demographics, clinical characteristics, previous diagnoses and hospitalisations, and diabetes medication history were used for propensity score matching. Subgroup analyses by ethnicity were performed. Effect size was estimated using risk ratios (RRs) with 95% confidence intervals (CIs).
Patients initiating SGLT2 inhibitors were more likely to achieve glycaemic control target than DPP4 inhibitor-treated patients (RR 1.09; 95% CI 1.04, 1.14). This was observed only in patients of Chinese ethnicity. A higher risk of diabetic ketoacidosis in SGLT2 inhibitor initiators was not observed. SGLT2 inhibitors were associated with reduced risk of hypoglycaemia (RR 0.69; 95% CI 0.59, 0.82) and urinary tract infection (RR 0.52; 95% CI 0.43, 0.63) but was not statistically significant for hypoglycaemia in Malay patients. Compared to DPP4 inhibitors, SGLT2 inhibitors were associated with 12% and 34% reduction in any-cause hospitalisation and all-cause mortality, respectively, potentially resulting in more than $50 million savings over 10 years.
SGLT2 inhibitors were associated with improvements in glycaemic control, reduced risk of complications, and was well tolerated. Ethnicity also plays a role and should be considered in future studies.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂和二肽基肽酶4（DPP4）抑制剂越来越多地被用作2型糖尿病患者的二线治疗药物。本研究旨在评估SGLT2抑制剂在新加坡多民族人群中的实际疗效。
这项回顾性队列研究从新加坡卫生部行政数据库中选取了被诊断患有糖尿病并接受治疗的患者。使用泊松回归评估治疗组之间的结局差异。人口统计学、临床特征、既往诊断和住院情况以及糖尿病用药史用于倾向评分匹配。按种族进行亚组分析。效应大小使用风险比（RR）和95%置信区间（CI）进行估计。
开始使用SGLT2抑制剂的患者比接受DPP4抑制剂治疗的患者更有可能实现血糖控制目标（RR 1.09；95% CI 1.04，1.14）。这仅在华裔患者中观察到。未观察到开始使用SGLT2抑制剂的患者发生糖尿病酮症酸中毒的风险更高。SGLT2抑制剂与低血糖风险降低（RR 0.69；95% CI 0.59，0.82）和尿路感染风险降低（RR 0.52；95% CI 0.43，0.63）相关，但在马来族患者中低血糖风险的降低无统计学意义。与DPP4抑制剂相比，SGLT2抑制剂分别使任何原因住院和全因死亡率降低了12%和34%，在10年内可能节省超过5000万美元。
SGLT2抑制剂与血糖控制改善、并发症风险降低相关，且耐受性良好。种族也起一定作用，未来研究应予以考虑。
