Sodium‐glucose co‐transporter‐2 inhibitors versus dipeptidyl peptidase‐4 inhibitors and the risk of heart failure: A nationwide cohort study of older adults with diabetes mellitus. Issue 4 (13th January 2021)

• Record Type: Journal Article
• Authors: Fralick, Michael; Colacci, Michael; Thiruchelvam, Deva; Gomes, Tara; Redelmeier, Donald A
• Is Part Of: Diabetes, obesity & metabolism. Volume 23:Issue 4(2021)
• Page Start: 950
• Page End: 960
• Publication Date: 2021-01-13
• Subjects: antidiabetic drug -- cardiovascular disease -- cohort study -- DPP‐4 inhibitor -- heart failure -- SGLT2 inhibitor; Diabetes -- Periodicals; Obesity -- Periodicals; Metabolism -- Disorders -- Periodicals; Clinical pharmacology -- Periodicals; 616.462
• DOI: 10.1111/dom.14300
• Languages: English
• ISSNs: 1462-8902

Abstract

Abstract: Aims: To analyse the rate of heart failure hospitalization for older adults prescribed a sodium‐glucose co‐transporter‐2 (SGLT2) inhibitor. Materials and Methods: The study cohort included adults aged 66 years and older diagnosed with diabetes mellitus in Ontario, Canada, between July 2015 and March 2019, who received either an SGLT2 inhibitor or a dipeptidyl peptidase‐4 (DPP‐4) inhibitor. The primary outcome was a composite of heart failure hospitalization and all‐cause mortality. Secondary outcomes included diabetic ketoacidosis and hypoglycaemia. Results: A total of 29 916 adults prescribed an SGLT2 inhibitor were compared with 29 916 adults prescribed a DPP‐4 inhibitor. The mean age was 72 years, 60% were men, the baseline glycated haemoglobin concentration was 8.2% and the baseline creatinine was 89 μmol/L. The incidence rate of the primary outcome was 19/1000 person‐years for adults prescribed an SGLT2 inhibitor compared to 38/1000 person‐years in those prescribed a DPP‐4 inhibitor. This resulted in a hazard ratio (HR) of 0.49 (95% confidence interval [CI] 0.45, 0.54) and a rate difference (RD) of 19 fewer events per 1000 person‐years (RD –19 [95% CI –22, –17]). Patients prescribed an SGLT2 inhibitor also had a lower rate of hypoglycaemia (HR 0.61 [95% CI 0.46, 0.81); RD –1.6 [95% CI –2.4, –0.8]), but a higher rate of diabetic ketoacidosis (HR 1.84 [95% CI 1.26, 2.70]; RD 1.0 [95% CI 0.4, 1.6]). Conclusions: Older adults prescribed an SGLT2 inhibitor had a lower rate of heart failure hospitalization or death, and a lower rate of hypoglycaemia, but an increased rate of diabetic ketoacidosis compared to older adults prescribed a DPP‐4 inhibitor.