Guo Ran, Pandey Ambarish, Chandramouli Chanchal, Wu Mei-Zhen, Cai An-Ping, Liu Ying-Xian, Ren Qing-Wen, Huang Jia-Yi, Zhang Jing-Nan, Gu Wen-Li, Xuan Hao-Chen, Ouwerkerk Wouter, Tromp Jasper, Teng Tiew-Hwa Katherine, Tsang Christopher Tze-Wei, Zhu Ching-Yan, Hung Yik-Ming, Lam Carolyn S P, Yiu Kai-Hang
Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Diabetes Obes Metab. 2025 Sep;27(9):4720-4728. doi: 10.1111/dom.16509. Epub 2025 Jun 13.
To compare the effectiveness of sodium-glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase 4 (DPP-4) inhibitors in reducing haemoglobin A1c (HbA1c) variability and improving cardiovascular and renal outcomes in patients with type 2 diabetes mellitus (T2DM) and high HbA1c variability.
This territory-wide cohort study involved patients with T2DM and an HbA1c variability score (HVS) >60% who initiated SGLT2 inhibitors or DPP-4 inhibitors in Hong Kong between 2015 and 2022. Propensity score (PS) matching was used to adjust for confounders. The primary outcome was post-treatment HVS within 3 years. Secondary outcomes included major adverse cardiovascular events (MACE) and serious renal events (SRE).
Among 20,205 T2DM patients with a baseline HVS >60%, 4,612 SGLT2 inhibitor users were 1:1 matched with DPP-4 inhibitor users. When referencing the 0%-20% quintile, patients initiating SGLT2 inhibitors versus DPP-4 inhibitors exhibited a reduced likelihood of being in higher HVS quintiles [21%-40%: odds ratio (OR) 0.76, 95% confidence interval (CI) 0.66-0.88; 41%-60%: OR 0.57, 95% CI 0.50-0.65; 61%-80%: OR 0.49, 95% CI 0.42-0.56; and 81%-100%: OR 0.40, 95% CI 0.34-0.47]. SGLT2 inhibitors were associated with a reduced risk of MACE [hazard ratio (HR) 0.69; 95% CI 0.60-0.79] and SRE (HR 0.71; 95% CI 0.63-0.80) compared to DPP-4 inhibitors.
In patients with high HbA1c variability, SGLT2 inhibitor initiation was associated with superior effectiveness in reducing HbA1c variability compared to DPP-4 inhibitors. The initiation of SGLT2 inhibitors versus DPP-4 inhibitors was linked to significantly reduced cardiovascular and renal adverse events.
比较钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂和二肽基肽酶4（DPP-4）抑制剂在降低2型糖尿病（T2DM）且糖化血红蛋白（HbA1c）变异性高的患者的HbA1c变异性以及改善心血管和肾脏结局方面的有效性。
这项全地区队列研究纳入了2015年至2022年期间在香港开始使用SGLT2抑制剂或DPP-4抑制剂的T2DM患者且HbA1c变异评分（HVS）>60%。采用倾向评分（PS）匹配来调整混杂因素。主要结局是3年内治疗后的HVS。次要结局包括主要不良心血管事件（MACE）和严重肾脏事件（SRE）。
在20205例基线HVS>60%的T2DM患者中，4612例SGLT2抑制剂使用者与DPP-4抑制剂使用者进行1:1匹配。与0%-20%五分位数相比，开始使用SGLT2抑制剂的患者与使用DPP-4抑制剂的患者相比，处于较高HVS五分位数的可能性降低[21%-40%：优势比（OR）0.76，95%置信区间（CI）0.66-0.88；41%-60%：OR 0.57，95%CI 0.50-0.65；61%-80%：OR 0.49，95%CI 0.42-0.56；81%-100%：OR 0.40，95%CI 0.34-0.47]。与DPP-4抑制剂相比，SGLT2抑制剂与MACE风险降低[风险比（HR）0.69；95%CI 0.60-0.79]和SRE风险降低（HR 0.71；95%CI 0.63-0.80）相关。
在HbA1c变异性高的患者中，与DPP-4抑制剂相比，开始使用SGLT2抑制剂在降低HbA1c变异性方面具有更高的有效性。与DPP-4抑制剂相比，开始使用SGLT2抑制剂与显著降低心血管和肾脏不良事件相关。
