Glucagon-like-peptide-1 receptor agonists versus dipeptidyl peptidase-4 inhibitors and cardiovascular outcomes in diabetes in relation to achieved glycemic control. A Danish nationwide study.
J Diabetes
; 16(6): e13560, 2024 Jun.
Article
em En
| MEDLINE
| ID: mdl-38751369
ABSTRACT
AIM:
To compare the cardiovascular preventive effect associated with glucagon-like-peptide-1 receptor agonists (GLP-1 RA) versus dipeptidyl peptidase-4 inhibitors (DPP-4i) according to the achieved target level of glycated hemoglobin (HbA1c).METHODS:
We used retrospective Danish registries to include type 2 diabetes patients already in metformin treatment initiating GLP-1 RA or DPP-4i between 2007 and 2021. Patients were included 6 months after GLP-1 RA or DPP-4i initiation. The last available HbA1c measurement before inclusion was collected. The achieved HbA1c level was categorized according to a target level below or above 53 mmol/mol (7%). The primary outcome was a composite of nonfatal myocardial infarction, nonfatal stroke, and all-cause death. We used a multivariable Cox proportional hazard model to estimate the effect of HbA1c levels on the outcome among GLP-1 RA users compared to DPP-4i users.RESULTS:
The study included 13 634 GLP-1 RA users (median age 56.9, interquartile range [IQR] 48.5-65.5; 53% males) and 39 839 DPP-4i users (median age 63.4, IQR 54.6-71.8; 61% males). The number of GLP-1 RA and DPP-4i users according to achieved HbA1c levels were as follows HbA1c ≤ 53 mmol/mol (≤7.0%) 3026 (22%) versus 4824 (12%); HbA1c > 53 mmol/mol (>7.0%) 6577 (48%) versus 17 508 (44%); missing HbA1c 4031 (30%) versus 17 507 (44%). During a median follow-up of 5 years (IQR 2.6-5.0), 954 GLP-1 RA users experienced the primary outcome compared to 7093 DPP-4i users. The 5-year risk (95% confidence interval [CI]) of the outcome associated with GLP1-RA versus DPP-4i according to HbA1c categories was as follows HbA1c ≤ 53 mmol/mol 10.3% (8.2-12.3) versus 24.3% (22.7-25.8); HbA1c > 53 mmol/mol 16.0% (14.3-17.6) versus 21.1% (20.3-21.9); missing HbA1c 17.1% (15.7-18.5) versus 25.6% (24.9-26.3). The preventive effect associated with GLP-1 RA versus DPP-4i was significantly enhanced when achieving lower HbA1c levels HbA1c ≤ 53 mmol/mol 0.65 (0.52-0.80); HbA1c > 53 mmol/mol 0.92 (0.83-1.03); missing HbA1c 0.92 (0.84-1.02) (p value for interaction <.001).CONCLUSION:
GLP-1 RA use was associated with a lower rate of major adverse cardiovascular outcomes. The association was stronger in patients achieving the target glycemic level and weaker in patients not achieving the target glycemic level, suggestive of an interaction between achieved HbA1c level and GLP-1 RA.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Hemoglobinas Glicadas
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Doenças Cardiovasculares
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Diabetes Mellitus Tipo 2
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Inibidores da Dipeptidil Peptidase IV
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Receptor do Peptídeo Semelhante ao Glucagon 1
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Controle Glicêmico
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Hipoglicemiantes
Limite:
Aged
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Female
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Humans
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Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
J Diabetes
Assunto da revista:
ENDOCRINOLOGIA
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Dinamarca