Comparing cardiovascular benefits between GLP-1 receptor agonists and SGLT2 inhibitors as an add-on to metformin among patients with type 2 diabetes: A retrospective cohort study

Christina E DeRemer; Scott M Vouri; Jingchuan Guo; William T Donahoo; Almut G Winterstein; Hui Shao

doi:10.1016/j.jdiacomp.2021.107972

Comparing cardiovascular benefits between GLP-1 receptor agonists and SGLT2 inhibitors as an add-on to metformin among patients with type 2 diabetes: A retrospective cohort study

J Diabetes Complications. 2021 Sep;35(9):107972. doi: 10.1016/j.jdiacomp.2021.107972. Epub 2021 Jun 11.

Authors

Christina E DeRemer¹, Scott M Vouri², Jingchuan Guo³, William T Donahoo⁴, Almut G Winterstein⁵, Hui Shao⁶

Affiliations

¹ Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA.
² Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA.
³ Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA.
⁴ Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
⁵ Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA; Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA; Department of Epidemiology, University of Florida College of Medicine and College of Public Health and Health Professions, Gainesville, FL, USA.
⁶ Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA. Electronic address: hui.shao@ufl.edu.

PMID: 34247911
DOI: 10.1016/j.jdiacomp.2021.107972

Abstract

Aims: This study aimed to compare cardiovascular benefits associated with the use of GLP-1RA versus SGLT2i as add-on therapies to metformin among adults with type 2 diabetes (T2D) with and without a history of cardiovascular complications, using real-world data.

Methods: Using data from the IBM® MarketScan® Commercial Claims Databases, metformin users above 18years with T2D who initiated GLP-1RA or SGLT2i were identified. The study endpoints include MI, stroke, CHF, and a cardiovascular composite of these three outcomes. Cox proportional hazard regression models were used to compare the risks of cardiovascular endpoints while controlling for demographics and clinical characteristics.

Results: We identified 13,006 adults with T2D who initiated a GLP-1RA or SGLT2i as an add-on therapy to metformin and followed for a maximum of 5years. No difference in the endpoints was observed between users of two drugs who did not have established cardiovascular disease at baseline. However, significantly lower CHF risks (HR: 0.47, 95% CI: 0.28-0.79) and cardiovascular composite (HR: 0.67, 95% CI: 0.47-0.97) were observed in SGLT2i users compared with GLP-1RA users, among individuals with established cardiovascular diseases.

Conclusions: Results suggest greater cardioprotective benefit from SGLT2i compared to GLP-1RA when used for secondary prevention among adults with T2D.

Keywords: Cardiovascular; Diabetes; GLP-1 receptor agonists; SGLT2 inhibitors; T2D.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adult
Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / prevention & control
Diabetes Mellitus, Type 2* / drug therapy
Diabetes Mellitus, Type 2* / epidemiology
Glucagon-Like Peptide-1 Receptor / agonists*
Humans
Hypoglycemic Agents / therapeutic use
Metformin* / therapeutic use
Retrospective Studies
Sodium-Glucose Transporter 2 Inhibitors* / therapeutic use

Substances

Glucagon-Like Peptide-1 Receptor
Hypoglycemic Agents
Sodium-Glucose Transporter 2 Inhibitors
Metformin

Grants and funding

U18 DP006512/DP/NCCDPHP CDC HHS/United States