Risk of morbidity and mortality in patients with type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitor and/or dipeptidyl peptidase-4 inhibitor: a nationwide study
Introduction Mortality and disability in diabetes mellitus are determined mostly by cardiovascular complications and cancer. The impact of dipeptidyl peptidase-4 inhibitor (DPP-4i) and sodium-glucose cotransporter-2 inhibitor (SGLT2i) monotherapy or combination on long-term complications of type 2 d...
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BMJ Publishing Group
2021-10-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/9/1/e001765.full |
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| author | Gyula Poór Gábor Sütő Gergő A Molnár Gyorgy Rokszin Ibolya Fábián Zoltan Kiss György Jermendy Peter Kempler István Wittmann |
| author_facet | Gyula Poór Gábor Sütő Gergő A Molnár Gyorgy Rokszin Ibolya Fábián Zoltan Kiss György Jermendy Peter Kempler István Wittmann |
| author_sort | Gyula Poór |
| collection | DOAJ |
| description | Introduction Mortality and disability in diabetes mellitus are determined mostly by cardiovascular complications and cancer. The impact of dipeptidyl peptidase-4 inhibitor (DPP-4i) and sodium-glucose cotransporter-2 inhibitor (SGLT2i) monotherapy or combination on long-term complications of type 2 diabetes mellitus was studied.Research design and methods Patients with type 2 diabetes treated with DPP-4i or SGLT2i during a 3-year period were identified in the database of the National Institute of Health Insurance Fund in Hungary. All-cause mortality, acute myocardial infarction, stroke, hospitalization for heart failure (HHF), lower limb amputation (LLA) and cancer were assessed. Outcomes of add-on SGLT2i to DPP-4i treatment in comparison with switching DPP-4i therapy to SGLT2i were also evaluated. After propensity score matching, survival analysis was performed with a Cox proportional hazards model.Results After propensity score matching, both SGLT2i and DPP-4i groups included 18 583 patients. All-cause mortality (HR, 0.80; 95% CI 0.68 to 0.94; p=0.0057), HHF (HR, 0.81; 95% CI 0.71 to 0.92; p=0.0018), and risk of cancer (HR, 0.75; 95% CI 0.66 to 0.86; p<0.0001) were lower in the SGLT2i population compared with DPP-4i. Risk of LLA was higher in the SGLT2i group (HR, 1.35; 95% CI 1.03 to 1.77; p=0.0315). SGLT2i in combination with DPP-4i results in lower all-cause mortality (HR, 0.46; 95% CI 0.31 to 0.67; p=0.0001), with a lower trend in stroke, LLA, HHF and cancer, but without any statistical difference.Conclusions SGLT2i treatment leads to a lower risk of overall mortality, HHF and cancer when compared with DPP-4i treatment. Adding SGLT2i to DPP-4i instead of switching from DPP-4i to SGLT2i further lowers the risk of all-cause mortality. |
| format | Article |
| id | doaj-art-e0b7b53cbea94d9b9fd36a0ad12d42b2 |
| institution | OA Journals |
| issn | 2052-4897 |
| language | English |
| publishDate | 2021-10-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-e0b7b53cbea94d9b9fd36a0ad12d42b22025-08-20T02:08:43ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-10-019110.1136/bmjdrc-2020-001765Risk of morbidity and mortality in patients with type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitor and/or dipeptidyl peptidase-4 inhibitor: a nationwide studyGyula Poór0Gábor Sütő1Gergő A Molnár2Gyorgy Rokszin3Ibolya Fábián4Zoltan Kiss5György Jermendy6Peter Kempler7István Wittmann8National Institute of Rheumatology & Physiology, Semmelweis University, Budapest, HungarySecond Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, HungarySecond Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, HungaryRxTarget Ltd, Szolnok, HungaryRxTarget Ltd, Szolnok, HungarySecond Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, HungaryBajcsy-Zsilinszky Hospital, Budapest, HungaryFirst Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, HungarySecond Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, HungaryIntroduction Mortality and disability in diabetes mellitus are determined mostly by cardiovascular complications and cancer. The impact of dipeptidyl peptidase-4 inhibitor (DPP-4i) and sodium-glucose cotransporter-2 inhibitor (SGLT2i) monotherapy or combination on long-term complications of type 2 diabetes mellitus was studied.Research design and methods Patients with type 2 diabetes treated with DPP-4i or SGLT2i during a 3-year period were identified in the database of the National Institute of Health Insurance Fund in Hungary. All-cause mortality, acute myocardial infarction, stroke, hospitalization for heart failure (HHF), lower limb amputation (LLA) and cancer were assessed. Outcomes of add-on SGLT2i to DPP-4i treatment in comparison with switching DPP-4i therapy to SGLT2i were also evaluated. After propensity score matching, survival analysis was performed with a Cox proportional hazards model.Results After propensity score matching, both SGLT2i and DPP-4i groups included 18 583 patients. All-cause mortality (HR, 0.80; 95% CI 0.68 to 0.94; p=0.0057), HHF (HR, 0.81; 95% CI 0.71 to 0.92; p=0.0018), and risk of cancer (HR, 0.75; 95% CI 0.66 to 0.86; p<0.0001) were lower in the SGLT2i population compared with DPP-4i. Risk of LLA was higher in the SGLT2i group (HR, 1.35; 95% CI 1.03 to 1.77; p=0.0315). SGLT2i in combination with DPP-4i results in lower all-cause mortality (HR, 0.46; 95% CI 0.31 to 0.67; p=0.0001), with a lower trend in stroke, LLA, HHF and cancer, but without any statistical difference.Conclusions SGLT2i treatment leads to a lower risk of overall mortality, HHF and cancer when compared with DPP-4i treatment. Adding SGLT2i to DPP-4i instead of switching from DPP-4i to SGLT2i further lowers the risk of all-cause mortality.https://drc.bmj.com/content/9/1/e001765.full |
| spellingShingle | Gyula Poór Gábor Sütő Gergő A Molnár Gyorgy Rokszin Ibolya Fábián Zoltan Kiss György Jermendy Peter Kempler István Wittmann Risk of morbidity and mortality in patients with type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitor and/or dipeptidyl peptidase-4 inhibitor: a nationwide study BMJ Open Diabetes Research & Care |
| title | Risk of morbidity and mortality in patients with type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitor and/or dipeptidyl peptidase-4 inhibitor: a nationwide study |
| title_full | Risk of morbidity and mortality in patients with type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitor and/or dipeptidyl peptidase-4 inhibitor: a nationwide study |
| title_fullStr | Risk of morbidity and mortality in patients with type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitor and/or dipeptidyl peptidase-4 inhibitor: a nationwide study |
| title_full_unstemmed | Risk of morbidity and mortality in patients with type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitor and/or dipeptidyl peptidase-4 inhibitor: a nationwide study |
| title_short | Risk of morbidity and mortality in patients with type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitor and/or dipeptidyl peptidase-4 inhibitor: a nationwide study |
| title_sort | risk of morbidity and mortality in patients with type 2 diabetes treated with sodium glucose cotransporter 2 inhibitor and or dipeptidyl peptidase 4 inhibitor a nationwide study |
| url | https://drc.bmj.com/content/9/1/e001765.full |
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