Novel glucose lowering agents are associated with a lower risk of cardiovascular and adverse events in type 2 diabetes: A population based analysis

Background and objectivesLittle is known about the comparative effects of dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), or sodium glucose cotransporter-2 (SGLT2) inhibitors on risk of AKI. This study aimed to compare the effects of these three novel classes of glucose-lowering drugs on AKI risk in patients with or without type 2 diabetes, by network meta-analysis of event-driven cardiovascular or kidney outcome trials.Design, setting, participants, & measurementsWe systematically searched electronic databases up to September 2020, and included 20 event-driven cardiovascular or kidney outcome trials (18 trials included patients with type 2 diabetes only, and two trials included patients with or without type 2 diabetes). A network meta-analysis using a frequentist approach was performed to compare the effects of DPP-4 inhibitors, GLP-1RAs, or SGLT2 inhibitors on risk of AKI, and estimate the probability for each intervention as the safest one. The primary analysis included 18 trials with type 2 diabetes only, and a secondary analysis included 20 trials.ResultsIn the 18 trials with a total of 2051 AKI events (range: 1–300) among 156,690 patients with type 2 diabetes only, our network meta-analysis showed that SGLT2 inhibitors were associated with a lower risk of AKI compared with placebo (odds ratio, 0.76; 95% confidence interval, 0.66 to 0.88), whereas both DPP-4 inhibitors and GLP-1RAs had neutral effects on risk of AKI. Moreover, SGLT2 inhibitors were significantly associated with a lower risk in AKI than both GLP-1RAs (odds ratio, 0.79; 95% confidence interval, 0.65 to 0.97) and DPP-4 inhibitors (odds ratio, 0.68; 95% confidence interval, 0.54 to 0.86). SGLT2 inhibitors have the highest probability of being the safest intervention (84%). The results were similar in the secondary analysis.ConclusionsCurrent evidence indicates that SGLT2 inhibitors have a lower risk of AKI than both DPP-4 inhibitors and GLP-1RAs.

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Comparative vascular safety of basal long-acting insulin analogue versus intermediate-acting human insulin in real-world patients with type 2 diabetes: a nationwide population-based cohort study

10.21203/rs.3.rs-16822/v1 ◽

2020 ◽

Author(s):

Chun-Ting Yang ◽

Kuan-Ying Li ◽

Chen-Yi Yang ◽

Huang-Tz Ou ◽

Shihchen Kuo

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Real World ◽

Basal Insulin ◽

Lower Risk ◽

Insulin Analogue ◽

Population Based ◽

Acting Insulin ◽

Long Acting

Abstract Background: Little is known about the comparative vascular safety of basal insulin (intermediate-acting human insulin [IAHI] or long-acting insulin analogue [LAIA]) in type 2 diabetes. We sought to examine the vascular and hypoglycemic effects associated with IAHI versus LAIA in real-world patients with type 2 diabetes. Methods: We conducted a nationwide population-based, retrospective cohort study using Taiwan’s National Health Insurance Research Database to include patients with type 2 diabetes who stably used an IAHI (N=11,521) or LAIA (N=37,651) in the period 2004-2012. A rigorous three-step matching algorithm that considered the initiation date of basal insulin, previous exposure of antidiabetic treatments, comorbidities, diabetes severity and complications, and concomitant medications was applied to achieve the between-group comparability. Study outcomes, including composite cardiovascular diseases (CVDs), composite microvascular diseases (MVDs), and hypoglycemia, were assessed up to the end of 2013. Results: Baseline patient characteristics were balanced with the application of the matching scheme. Compared with LAIA, the use of IAHI was associated with greater risks of composite CVDs (adjusted hazard ratio: 1,79; 95% confidence interval: 1.20-2.67) and hospitalized hypoglycemia (1.82; 1.51-2.20), but a lower risk of composite MVDs (0.88; 0.84-0.91). Subgroup and sensitivity analyses showed a consistent trend of results with that in the primary analyses. Conclusions: The use of a basal insulin with IAHI versus LAIA among patients with type 2 diabetes in usual practice may be associated with a lower risk of MVDs, and strategies should be optimized for minimizing the risks of hypoglycemia and CVDs in this population.

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Novel oral glucose-lowering drugs are associated with lower risk of all-cause mortality, cardiovascular events and severe hypoglycaemia compared with insulin in patients with type 2 diabetes

Diabetes Obesity and Metabolism ◽

10.1111/dom.12889 ◽

2017 ◽

Vol 19 (6) ◽

pp. 831-841 ◽

Cited By ~ 46

Author(s):

Thomas Nyström ◽

Johan Bodegard ◽

David Nathanson ◽

Marcus Thuresson ◽

Anna Norhammar ◽

...

Keyword(s):

Type 2 Diabetes ◽

Lower Risk ◽

Cardiovascular Events ◽

Severe Hypoglycaemia ◽

Oral Glucose ◽

Glucose Lowering ◽

All Cause Mortality

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Changes in HbA1c and frequency of measuring HbA1c and adjusting glucose-lowering medications in the 10 years following diagnosis of type 2 diabetes: a population-based study in the UK

Diabetologia ◽

10.1007/s00125-014-3250-8 ◽

2014 ◽

Vol 57 (8) ◽

pp. 1586-1594 ◽

Cited By ~ 8

Author(s):

Marcus Lind ◽

Aldina Pivodic ◽

Lucia Cea-Soriano ◽

Olle Nerman ◽

Nils-Gunnar Pehrsson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Population Based ◽

Population Based Study ◽

Glucose Lowering ◽

The Uk

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Association between Gout, Urate-Lowering Therapy, and Risk of Developing Type 2 Diabetes Mellitus: A Nationwide Population-Based Retrospective Cohort Study

BioMed Research International ◽

10.1155/2020/6358954 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Yi-Jen Fang ◽

Yun-Lung Chung ◽

Cheng-Li Lin ◽

Yun-Ping Lim

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Lower Risk ◽

Population Based ◽

Case Group ◽

Control Cohort ◽

Lowering Therapy ◽

Cox Proportional Hazard Regression

Gout is the most prevalent inflammatory arthritis in adults. Although the link between gout and type 2 diabetes mellitus (T2DM) has been documented, our understanding of the association between urate-lowering therapy (ULT) among gout patients and T2DM development remains poor. We included 69,326 patients with new-onset gout in 2000-2011. Each case was matched randomly with 1 patient without gout during the study period, and 69,326 patients were recognized as the comparison cohort. A Cox proportional hazard regression model was used to analyze differences in the risk of T2DM development between patients with and without gout after considering related comorbidities. After adjusting for potential confounders, the case group had a higher risk of T2DM than the control cohort (adjusted hazard ratio aHR=1.30, 95%confidence interval CI=1.24-1.38; P<0.001). Gout patients without appropriate ULT had significantly higher risk of T2DM development than the control cohort (aHR=1.39; 95%CI=1.30-1.48; P<0.001). Among gout patients, those receiving ULT excluding probenecid (aHR=0.80; 95%CI=0.64-1.00), all had significantly lower risk of T2DM than gout patients without ULT (all aHR<0.90; all P<0.001). In this study, we found that gout increased the risk of T2DM; however, patients with any ULT exhibited a lower risk of T2DM than gout patients without any ULT (all aHR<0.90, P<0.001; excluding probenecid).

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