Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2024.3806 Tao Huang et al.
Points
- The study found that patients with type 2 diabetes (T2D) using GLP-1 receptor agonists (GLP-1RAs) had a significantly lower risk of hyperkalemia compared to those using DPP-4 inhibitors (DPP-4is), with a hazard ratio (HR) of 0.61 for any hyperkalemia and 0.52 for moderate to severe hyperkalemia.
- Among patients using renin-angiotensin system inhibitors (RASis), those treated with GLP-1RAs were less likely to discontinue RASi therapy, with a hazard ratio of 0.89, suggesting better persistence with these essential cardiovascular and kidney-protective treatments.
- The study used inverse probability of treatment weights to adjust for confounders, ensuring robust evidence on the comparative safety and effectiveness of GLP-1RAs versus DPP-4is in this population.
- The study’s median duration of treatment was relatively short, at 3.9 months, but the findings were consistent across various demographic and clinical subgroups.
- The results support the wider use of GLP-1RAs in patients with T2D to reduce hyperkalemia risk and enhance the continuation of RASi therapy. This could have long-term cardiovascular and kidney health benefits in this high-risk population.
Summary
In a cohort study conducted in Stockholm, Sweden, researchers examined the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) compared to dipeptidyl peptidase-4 inhibitors (DPP-4is) on rates of hyperkalemia and the persistence of renin-angiotensin system inhibitor (RASi) use in 33,280 patients with type 2 diabetes (T2D). This analysis was particularly significant given the common complication of hyperkalemia in this population, which can restrict the use of RASis, medications essential for managing cardiovascular and kidney risks. The study, which spanned from January 2008 to December 2021, utilized inverse probability of treatment weights to adjust for confounders, providing robust evidence of these treatments’ comparative safety and effectiveness.
Results indicated a statistically significantly lower rate of hyperkalemia in patients using GLP-1RAs than those using DPP-4is. Specifically, the hazard ratio (HR) for any hyperkalemia was 0.61 (95% CI, 0.50-0.76), and for moderate to severe hyperkalemia, the HR was 0.52 (95% CI, 0.28-0.84). Additionally, among the 21,751 participants using RASis at baseline, those treated with GLP-1RAs were less likely to discontinue RASi therapy (HR, 0.89; 95% CI, 0.82-0.97). The median treatment duration was 3.9 months (IQR 1.0-10.9 months), with consistent findings across various demographic and clinical subgroups.
These findings underscore the potential benefits of GLP-1RA therapy in reducing the risk of hyperkalemia and enhancing the persistence of RASi therapy in patients with T2D, thus supporting the broader use of guideline-recommended therapies. The lower incidence of hyperkalemia with GLP-1RA use suggests a viable strategy for maintaining essential cardiovascular and renoprotective treatments in this high-risk population. Further studies are warranted to explore the long-term clinical benefits of this therapeutic approach in routine care settings.
Link to the article: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2821737
References Huang, T., Bosi, A., Faucon, A.-L., Grams, M. E., Sjölander, A., Fu, E. L., Xu, Y., & Carrero, J. J. (2024). GLP-1RA vs DPP-4i Use and Rates of Hyperkalemia and RAS Blockade Discontinuation in Type 2 Diabetes. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2024.3806
