Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
J Diabetes. 2024 Apr;16(4):e13507. doi: 10.1111/1753-0407.13507.
We investigated the association between post-hospital discharge use of sodium glucose cotransporter-2 inhibitors (SGLT-2is) compared to dipeptidyl peptidase-4 inhibitors (DPP-4is) and the incidence of hospitalization for acute renal failure (ARF) and chronic kidney disease (CKD) in people with type 2 diabetes.
We conducted a retrospective cohort study using linked hospital and prescription data. Our cohort included people aged ≥30 years with type 2 diabetes discharged from a hospital in Victoria, Australia, from December 2013 to June 2018. We compared new users of SGLT-2is with new users of DPP-4is following discharge. People were followed from first dispensing of a SGLT-2i or DPP-4i to a subsequent hospital admission for ARF or CKD. We used competing risk models with inverse probability of treatment weighting (IPTW) to estimate subhazard ratios.
In total, 9620 people initiated SGLT-2is and 9962 initiated DPP-4is. The incidence rate of ARF was 12.3 per 1000 person-years (median years of follow-up [interquartile range [IQR] 1.4 [0.7-2.2]) among SGLT-2i initiators and 18.9 per 1000 person-years (median years of follow-up [IQR] 1.7 [0.8-2.6]) among DPP-4i initiators (adjusted subhazard ratio with IPTW 0.78; 95% confidence interval [CI] 0.70-0.86). The incidence rate of CKD was 6.0 per 1000 person-years (median years of follow-up [IQR] 1.4 [0.7-2.2]) among SGLT-2i initiators and 8.9 per 1000 person-years (median years of follow-up [IQR] 1.7 [0.8-2.6]) among DPP-4i initiators (adjusted subhazard ratio with IPTW 0.83; 95% CI 0.73-0.94).
Real-world data support using SGLT-2is over DPP-4is for preventing acute and chronic renal events in people with type 2 diabetes.
我们研究了 2 型糖尿病患者出院后使用钠葡萄糖共转运蛋白 2 抑制剂 (SGLT-2is) 与二肽基肽酶-4 抑制剂 (DPP-4is) 相比，与因急性肾衰竭 (ARF) 和慢性肾脏病 (CKD) 住院的发生率之间的关系。
我们使用链接的医院和处方数据进行了回顾性队列研究。我们的队列包括 2013 年 12 月至 2018 年 6 月期间从澳大利亚维多利亚州的一家医院出院的年龄≥30 岁的 2 型糖尿病患者。我们比较了 SGLT-2is 的新使用者和 DPP-4is 的新使用者。患者从首次使用 SGLT-2i 或 DPP-4i 开始随访，直至因 ARF 或 CKD 住院。我们使用逆概率治疗加权 (IPTW) 竞争风险模型估计亚危险比。
共有 9620 人开始使用 SGLT-2is，9962 人开始使用 DPP-4is。ARF 的发生率为 SGLT-2i 使用者为 12.3/1000 人年（中位数随访年限[四分位距[IQR]为 1.4[0.7-2.2]），DPP-4i 使用者为 18.9/1000 人年（中位数随访年限[IQR]为 1.7[0.8-2.6]）（校正 IPTW 后的亚危险比为 0.78；95%置信区间[CI]为 0.70-0.86）。CKD 的发生率为 SGLT-2i 使用者为 6.0/1000 人年（中位数随访年限[IQR]为 1.4[0.7-2.2]），DPP-4i 使用者为 8.9/1000 人年（中位数随访年限[IQR]为 1.7[0.8-2.6]）（校正 IPTW 后的亚危险比为 0.83；95%CI 为 0.73-0.94）。
真实世界的数据支持在 2 型糖尿病患者中使用 SGLT-2is 而不是 DPP-4is 来预防急性和慢性肾脏事件。
