Article Impact Level: HIGH Data Quality: STRONG Summary of Annals of Internal Medicine, 175(7), 927–937. https://doi.org/10.7326/M21-4012 Dr. HoJin Shin et al
Points
- The study compared the cardiovascular effects of metformin versus SGLT-2i (canagliflozin, empagliflozin, or dapagliflozin) in patients with type 2 diabetes (T2D). Contrary to metformin, the use of sodium-glucose cotransporter 2 inhibitors (SGLT-2i) in individuals with type 2 diabetes was linked to a lower incidence of composite heart failure and overall mortality
- After a one-year follow-up, genital infections were more common in the SGLT-2i group
Summary
Recent clinical studies have shown that the usage of SGLT-2i has cardioprotective advantages. In light of this, recent recommendations urge individuals with type 2 diabetes and concomitant cardiovascular disease to use SGLT-2i as their first line of treatment. The majority of studies, however, have only looked at SGLT-2i as a second-line option for diabetic patients.
The current population-based cohort research examined one-year cardiovascular outcomes in patients with type 2 diabetes who were treated with either SGLT-2i or metformin using claims data from two sizable U.S. commercial and Medicare resources (April 2013 to March 2020). Patients with T2D who started therapy with SGLT-2i or metformin between April 2013 and March 2020 and were 18 years of age or older (>65 years in Medicare) and had never used any antidiabetic drugs prior to cohort admission were identified. The primary outcomes were hospitalizations for myocardial infarction (MI), ischemic or hemorrhagic stroke, or all-cause mortality (MI/stroke/mortality), and hospitalizations for heart failure (HHF) or all-cause death (HHF/mortality). Genital infections and other safety compliance were evaluated.
During a mean follow-up of 12 months, 8613 first-line SGLT-2i initiators had a major risk for MI, stroke, and mortality compared to 17 226 metformin initiators, but a decreased risk for HHF/mortality. Compared to metformin initiators, SGLT-2i initiators exhibited significantly decreased rates of composite all-cause mortality and incidence of heart failure hospitalization. Rates of harmful cardiovascular events did not significantly differ across groups. With the exception of a greater incidence of genital infections in the SGLT-2i group, the safety profile was similar for metformin initiators and SGLT-2i. The dependence on observational data, which limited the capacity to control for diabetes severity and socioeconomic factors, was a weakness of this study. Additionally, the data did not adequately reflect participants of different races, which restricted the applicability of the study’s conclusions.
Link to the article: https://www.acpjournals.org/doi/10.7326/M21-4012
References Shin, H., Schneeweiss, S., Glynn, R. J., & Patorno, E. (2022). Cardiovascular outcomes in patients initiating first-line treatment of type 2 diabetes with sodium–glucose cotransporter-2 inhibitors versus metformin. Annals of Internal Medicine, 175(7), 927–937. https://doi.org/10.7326/M21-4012
