Risk of Cardiovascular Outcomes in Type 2 Diabetes Patients Following Addition of SGLT-2 Inhibitors Versus Sulfonylureas to Baseline GLP-1RA Therapy
The cardiovascular benefit of glucagon-like peptide agonists (GLP-1RA) or sodium-glucose cotransporter-2 inhibitors (SGLT-2i), when incorporated individually in type 2 diabetes, is well established. While many patients are to be prescribed both the drugs, the benefits of adding SGLT2i to GLP-1RA therapy is unknown.
The author Dave and colleagues conducted research titled “Risk of Cardiovascular Outcomes in Type 2 Diabetes Patients Following Addition of SGLT2 Inhibitors Versus Sulfonylureas to Baseline GLP-IRA Therapy” published in the journal of the “American Heart Association”. The summary of findings is below:
Objectives:
To investigate if the addition of SGLT2i to GLP-1RA decreases cardiovascular events compared to GLP-1RA alone.
Method:
Out of 3 US claims datasets, patients introduced either SGLT2i or sulfonylureas to GLP-1RA were selected. There were 1:1 propensity score-matched (PSM) adjusting for more than 95 baseline covariates. The primary outcomes included composite cardiovascular endpoint (CCE; composed of myocardial infarction, stroke, and all-cause mortality) and heart failure hospitalization. Using fixed-effects meta-analysis, adjusted hazard ratios (HR) and 95% confidence intervals (CI) were estimated.
Findings:
A study reports that the initiation of SGLT2i decreases the risk of a CCE outcome and HF hospitalizations, compared to the administration of sulfonylureas in patients with existing GLP-1RA therapy.
Investigators outline several barriers that might arise while adding SGLT2i in patients using GLP-1RA therapy. It includes high drug expenses, patient unwillingness to injectable therapy, and long-term adherence to the glucose-lowering regimens. Additionally, the study also highlights the set of the adverse effects associated with GLP1-RA (gastrointestinal intolerance, other) and SGLT2i (diabetic ketoacidosis and genital infections), which need to be considered while prescribing.
Limitations:
As this is an observational study, there are chances of residual confounding. Secondly, a 180-day period was used to define treatment initiation with the aim that some patients may have been exposed to the treatment before this time window. Lastly, the authors acknowledge that individual agents might have contributed disproportionately to findings as therapeutics were assessed by drug class.
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