Yen Fu-Shun, Wei James Cheng-Chung, Huang Yu-Han, Li Pei-Yun, Tsai Fuu-Jen, Hsu Chih-Cheng, Hwu Chii-Min
Dr. Yen's Clinic, No. 15, Shanying Road, Gueishan District, Taoyuan 33354, Taiwan.
Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City 40201, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung City 40201, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung 40402, Taiwan.
Diabetes Res Clin Pract. 2025 Aug;226:112328. doi: 10.1016/j.diabres.2025.112328. Epub 2025 Jun 16.
To compare the risks of cardiovascular events and major microvascular complications associated with adding sodium-glucose cotransporter-2 (SGLT2) inhibitors versus dipeptidyl peptidase-4 (DPP-4) inhibitors or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) to insulin therapy in patients with type 2 diabetes (T2D).
Using Taiwan's National Health Insurance Research Database (2008-2021), we identified 20,655 propensity score-matched pairs of SGLT2 inhibitor and DPP-4 inhibitor users, and 10,445 matched pairs of SGLT2 inhibitor and GLP-1 RA users, all receiving concurrent insulin therapy. Cox proportional hazards models were applied to assess outcome risks.
SGLT2 inhibitor use was associated with significantly lower risks of major microvascular complications compared to both DPP-4 inhibitors (adjusted hazard ratio [aHR] 0.37, 95% CI: 0.33-0.41) and GLP-1 RAs (aHR 0.57, 95% CI: 0.49-0.66). Compared with DPP-4 inhibitors, SGLT2 inhibitors also conferred a lower risk of major adverse cardiovascular events (aHR 0.57, 95% CI: 0.53-0.61) and all-cause mortality (aHR 0.42, 95% CI: 0.39-0.45).
In patients with T2D on insulin, adding SGLT2 inhibitors was associated with lower risks of cardiovascular events, major microvascular complications, and mortality compared to DPP-4 inhibitors, and lower risk of major microvascular complications compared to GLP-1 RAs.
比较在2型糖尿病（T2D）患者中，胰岛素治疗基础上加用钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂与二肽基肽酶-4（DPP-4）抑制剂或胰高血糖素样肽-1受体激动剂（GLP-1 RAs）相关的心血管事件风险和主要微血管并发症风险。
利用台湾地区国民健康保险研究数据库（2008 - 2021年），我们确定了20655对倾向评分匹配的SGLT2抑制剂使用者和DPP-4抑制剂使用者，以及10445对匹配的SGLT2抑制剂使用者和GLP-1 RAs使用者，所有这些患者均接受同步胰岛素治疗。应用Cox比例风险模型评估结局风险。
与DPP-4抑制剂（调整后风险比[aHR] 0.37，95%置信区间：0.33 - 0.41）和GLP-1 RAs（aHR 0.57，95%置信区间：0.49 - 0.66）相比，使用SGLT2抑制剂与主要微血管并发症风险显著降低相关。与DPP-4抑制剂相比，SGLT2抑制剂还具有较低的主要不良心血管事件风险（aHR 0.57，95%置信区间：0.53 - 0.61）和全因死亡率（aHR 0.42，95%置信区间：0.39 - 0.45）。
在接受胰岛素治疗的T2D患者中，与DPP-4抑制剂相比，加用SGLT2抑制剂与心血管事件、主要微血管并发症和死亡率风险较低相关，与GLP-1 RAs相比，主要微血管并发症风险较低。
