Kidney and Cardiovascular Effectiveness of SGLT2 Inhibitors vs GLP-1 Receptor Agonists in Type 2 Diabetes.
J Am Coll Cardiol
; 84(8): 696-708, 2024 Aug 20.
Article
in En
| MEDLINE
| ID: mdl-39142723
ABSTRACT
BACKGROUND:
Emerging data suggest that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) improve kidney outcomes for people with type 2 diabetes (T2D). Direct comparisons of the kidney and cardiovascular effectiveness of GLP-1 RA with sodium-glucose cotransporter 2 inhibitors (SGLT2i), a first-line therapy for this population, are needed.OBJECTIVES:
The authors compared kidney and cardiovascular outcomes for new users of SGLT2i and GLP-1 RAs with T2D.METHODS:
Using propensity score overlap weighting, we analyzed electronic health record data from 20 U.S. health systems contributing to PCORnet between 2015 and 2020. The primary kidney outcome was a composite of sustained 40% estimated glomerular filtration rate (eGFR) decline, incident end-stage kidney disease, or all-cause mortality over 2 years or until censoring. In addition, we examined cardiovascular and safety outcomes.RESULTS:
The weighted study cohort included 35,004 SGLT2i and 47,268 GLP-1 RA initiators. Over a median of 1.2 years, the primary outcome did not differ between treatments (HR 0.91; 95% CI 0.81-1.02), although SGLT2i were associated with a lower risk of 40% eGFR decline (HR 0.77; 95% CI 0.65-0.91). Risks of mortality (HR 1.08; 95% CI 0.92-1.27), a composite of stroke, myocardial infarction, or death (HR 1.03; 95% CI 0.93-1.14), and heart failure hospitalization (HR 0.95; 95% CI 0.80-1.13) did not differ. Genital mycotic infections were more common for SGLT2i initiators, but other safety outcomes did not differ. The results were similar regardless of chronic kidney disease status.CONCLUSIONS:
SGLT2i and GLP-1 RAs led to similar kidney and cardiovascular outcomes in people with T2D, though SGLT2i initiation was associated with a lower risk of 40% eGFR decline. (Evaluating Comparative Effectiveness of Empagliflozin in Type 2 Diabetes Population With and Without Chronic Kidney Disease; NCT05465317).Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Diabetes Mellitus, Type 2
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Glucagon-Like Peptide-1 Receptor
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Sodium-Glucose Transporter 2 Inhibitors
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Glomerular Filtration Rate
Limits:
Aged
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Female
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Humans
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Male
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Middle aged
Language:
En
Journal:
J Am Coll Cardiol
Year:
2024
Document type:
Article
Country of publication:
United States