Cardiovascular and renal outcomes among patients with type 2 diabetes using SGLT2 inhibitors added to metformin: a population-based cohort study from the UK.
BMJ Open Diabetes Res Care
; 11(1)2023 01.
Article
em En
| MEDLINE
| ID: mdl-36596641
ABSTRACT
INTRODUCTION:
Large numbers of patients with type 2 diabetes receive treatment with a sodium-glucose co-transporter-2 inhibitor (SGLT2i). We investigated whether the cardiorenal preventative effects found in clinical trials are also seen in clinical practice where patient characteristics and adherence to treatment differ. RESEARCH DESIGN ANDMETHODS:
Using UK primary care electronic health records, we followed two cohorts of patients with type 2 diabetes prescribed metformin SGLT2is (N=12 978) and a matched comparator of patients not using an SGLT2i at the start of follow-up (N=44 286). Independent follow-ups were performed to identify the studyoutcomes:
cardiovascular (CV) composite (comprising non-fatal myocardial infarction (MI)/ischemic stroke (IS) requiring hospitalization and CV death), severe renal disease, and all-cause mortality. Cox regression was used to estimate adjusted HRs.RESULTS:
Mean follow-up was 2.3 years (SGLT2i cohort) and 2.1 years (comparison cohort). Mean age was 59.6 years (SD ±10.2, SGLT2i cohort) and 60.4 years (SD ±10.0, comparison cohort). SGLT2i new users were associated with a reduced risk of the CV composite (HR 0.75, 95% CI 0.61 to 0.93), severe renal disease (HR 0.55, 95% CI 0.46 to 0.67), and all-cause mortality (HR 0.56, 95% CI 0.49 to 0.63), with risk reductions similar irrespective of baseline chronic kidney disease. Reduced risks were seen for IS (HR 0.51, 95% CI 0.36 to 0.74) but not MI (HR 0.98, 95% CI 0.74 to 1.28). Results were consistent in sensitivity analyses.CONCLUSIONS:
In this population-based study, SGLT2is were associated with significant CV, renal and survival benefits among individuals with type 2 diabetes on metformin; the CV benefit was driven by a reduced risk of ischemic stroke.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Acidente Vascular Cerebral
/
Diabetes Mellitus Tipo 2
/
Inibidores do Transportador 2 de Sódio-Glicose
/
AVC Isquêmico
/
Metformina
/
Infarto do Miocárdio
Tipo de estudo:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
BMJ Open Diabetes Res Care
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Espanha