*For medical professionals only
“img class=”responsive ” sizes=”(min-width: 320px) 320px, 100vw” src=”https://mmbiz.qpic.cn/mmbiz_png/x5F5KAyDKw19I4VvcibrfNia7lD1fial5KribXqZxjxMxtoc3ichKKz6ib3w5kJias8QNRBYGn80MM0AxEgOvRLib>p>width=”6400″ >sodium–glucose cotransporter2inhibitor (< /span>SGLT2i) showed benefit over placebo in the Cardiovascular Outcomes Trial (CVOTs), including Reduced hospitalization for heart failure (HHF) in study populations with vascular disease (CVD) or high cardiovascular risk risk. Starting in 2018,SGLT2i has been recognized as the preferred second-line treatment, Recently recommended for 2type diabetes (T2DM) and >First-line drugs for CVDpatients.
Compared with the evidence of SGLT2i benefit from large CVOTs involving thousands of patients with T2DM, the evidence for metformin was mainly from subgroup findings of the UK Prospective Diabetes Study, Among the 342 participants randomized to metformin, the risk of myocardial infarction (MI) and all-cause death was reduced compared with diet alone.
However, the trial results may not be informative for people with a history of cardiovascular disease, because patients with established CVD were excluded, but they accounted for 16 of those requiring first-line antidiabetic therapy. % to 19%.
Existing studies have focused on the efficacy of SGLT2i as a second-line treatment, and there is limited evidence for the risk of cardiovascular events with first-line SGLT2i compared with metformin, especially in patients with pre-existing cardiovascular disease. patient.
Recently, the Annals of Internal Medicine published a study evaluating the risk of cardiovascular events in adult patients with T2DM who initiated first-line SGLT2i versus metformin therapy in clinical practice.
Study Design
Study Design: Population-Based array research.
Study Setting: Claims data from two large US commercial and health insurance databases (April 2013 to March 2020).
Enrolled population:
18 patients who started SGLT2i or metformin between April 2013 and March 2020 T2DM patients aged and older (>65 years in Medicare) who had not used any antidiabetic medication prior to entry into the cohort.
After 1:2 propensity score matching in each database, pooled hazard ratios (HRs) and 95% CIs were reported.
Interventions: first-line SGLT2i (canagliflozin, empagliflozin, or dapagliflozin) or metformin.
Primary endpoint: composite of myocardial infarction (MI) hospitalization, ischemic or hemorrhagic stroke hospitalization, or all-cause death (MI/stroke/death), and heart failure A composite of hospitalization (HHF) or all-cause death (HHF/death).
Safety endpoints: Safety endpoints including genital infections were assessed.
Results
In 8613 first-line SGLT- Among 2i initiators matched to 17,226 metformin initiators, SGLT2i initiators had similar MI/stroke/death risk and lower HHF/death risk at a mean follow-up of 12 months.
Similar risk of MI/stroke/death: HR, 0.96; 95% CI, 0.77-1.19;
more Low risk of HHF/death: HR, 0.80; 95% CI, 0.66-0.97.
Compared with metformin, the population starting SGLT2i showed a lower risk of HHF and MI, similar stroke, death, and MI/ Risk of stroke/HHF/death.
Lower risk of HHF: HR, 0.78; 95% CI, 0.63-0.97,
Lower MI Risk: HR, 0.70; 95% CI, 0.48-1.00.
People who initiate SGLT2i therapy have a higher risk of genital infection and are otherwise similar in safety to metformin.
Higher risk of genital infection: HR, 2.19; 95% CI, 1.91 to 2.51.
Kaplan-Meier curve for cumulative incidence of the primary endpoint
< p>Studies comparing SGLT-2i to metformin after 1:2 propensity score matching
CONCLUSION
As first-line treatment for T2DM, populations initiating SGLT2i showed similar MI/stroke/death risk, lower HHF/death and HHF risk, and was significantly associated with metformin The safety profile was similar, except for an increased risk of genital infections, compared with the population of 2000.
A limitation of this study is that treatment selection was not randomized.
Review Highlights
< span>In this population-based cohort study, two large US insurance databases were used to compare cardiovascular outcomes in adults with T2D who initiated SGLT2i versus metformin.
First-line initiators of SGLT2i had similar risks of myocardial infarction, hospitalization for ischemic or hemorrhagic stroke, or all-cause death, hospitalization for heart failure, and total The risk of death is low.
This retrospective study supports the use of SGLT2i in the first-line treatment of T2DM to reduce the risk of cardiovascular outcomes, especially Heart failure. However, further prospective studies are needed.
Source: p>
Cardiovascular Outcomes in Patients Initiating First-Line Treatment of Type 2 Diabetes With Sodium-Glucose Cotransporter-2 Inhibitors Versus Metformin: A Cohort Study. Ann Intern Med. 2022 May 24. doi: 10.7326/M21- 4012.
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