scholarly journals Comparative effects of sodium glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP4) inhibitors on new-onset atrial fibrillation and stroke outcomes

2021 ◽  
Author(s):  
Sharen Lee ◽  
Jiandong Zhou ◽  
Carlin Chang ◽  
Tong Liu ◽  
Dong Chang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Propensity Score ◽  
Lower Risk ◽  
Sglt2 Inhibitors ◽  
All Cause Mortality ◽  
New Onset

AbstractBackgroundSGLT2I and DPP4I are medications prescribed for type 2 diabetes mellitus patients. However, there are few population-based studies comparing their effects on incident atrial fibrillation or ischemic stroke.MethodsThis was a territory-wide cohort study of type 2 diabetes mellitus patients prescribed SGLT2I or DPP4I between January 1st, 2015 to December 31st, 2019 in Hong Kong. Patients with both DPP4I and SGLT2I use and patients with drug discontinuation were excluded. Patients with prior AF or stroke were excluded for the respective analysis. 1:2 propensity-score matching was conducted for demographics, past comorbidities and medications using nearest-neighbor matching method. Cox models were used to identify significant predictors for new onset heart failure (HF) or myocardial infarction (MI), cardiovascular and all-cause mortality.ResultsThe AF-free cohort included 49108 patients (mean age: 66.48 years old [SD: 12.89], 55.32% males) and the stroke-free cohort included 49563 patients (27244 males [54.96%], mean baseline age: 66.7 years old [SD: 12.97, max: 104.6 years old]). After propensity score matching, SGLT2i use was associated with a lower risk of new onset AF (HR: 0.43[0.28, 0.66]), cardiovascular mortality (HR: 0.79[0.58, 1.09]) and all-cause mortality (HR: 0.69[0.60, 0.79]) in the AF-free cohort. It was also associated with a lower risk of new onset stroke (0.46[0.33, 0.64]), cardiovascular mortality (HR: 0.74[0.55, 1.00]) and all-cause mortality (HR: 0.64[0.56, 0.74]) in the stroke-free cohort.ConclusionsThe novelty of our work si that SGLT2 inhibitors are protective against atrial fibrillation and stroke development for the first time. These findings should be validated in other cohorts.

scholarly journals The risk of new-onset atrial fibrillation in patients with type 2 diabetes mellitus treated with sodium glucose cotransporter 2 inhibitors versus dipeptidyl peptidase-4 inhibitors

2020 ◽  
Author(s):  
Ann Wan-Chin Ling ◽  
Cze-Ci Chan ◽  
Shao-Wei Chen ◽  
Wei-Yi Kao ◽  
Chien-Ying Huang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lower Risk ◽  
Dipeptidyl Peptidase 4 ◽  
Sodium Glucose Cotransporter ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background: Sodium glucose cotransporter 2 inhibitor (SGLT2i) reduces the risk of hard cardiovascular endpoints in type 2 diabetes mellitus (T2DM) patients with/without established cardiovascular diseases. Whether SGLT2i is associated with a lower risk of new-onset atrial fibrillation (AF) in T2DM patients is unclear. We aimed to evaluate the risk of new-onset AF associated with the use of SGLT2i compared to dipeptidyl peptidase-4 inhibitor (DPP4i) among a longitudinal cohort of diabetic patients. Methods: We used medical data from a multi-center healthcare provider in Taiwan, which included a total of 15,606 and 12,383 patients treated with SGLT2i and DPP4i, respectively, from June 1, 2016 to December 31, 2018. We used propensity-score weighting to balance covariates across study groups. Patients were followed up from the drug index date until the occurrence of new-onset AF, discontinuation of the index drug, or the end of the study period, whichever occurred first. Results: Overall, 55%, 45%, and 0% of the patients were treated with empagliflozin, dapagliflozin, and canagliflozin, respectively. Most patients in the DPP4i group were prescribed with linagliptin (51%), followed by sitagliptin (24%), saxagliptin (13%), vildagliptin (8%) and alogliptin (5%). The use of SGLT2i was associated with a lower risk of new-onset AF compared with DPP4i after propensity-score weighting [hazard ratio: 0.61; 95% confidential interval: 0.50-0.73; P< 0.001]. Subgroup analysis revealed that the use of SGLT2i was associated with a lower risk of new-onset AF compared with DPP4i across several subgroups including old age, female in gender, the presence of cardiovascular disease, hemoglobin A1c 8%, and chronic kidney disease. The advantage of SGLT2i over DPP4i persisted with different SGLT2i (dapagliflozin or empagliflozin) and either low- or standard-dose SGLT2i. Conclusions: SGLT2i was associated with a lower risk of new-onset AF compared with DPP4i among T2DM patients in real-world practice.

scholarly journals The risk of new-onset atrial fibrillation in patients with type 2 diabetes mellitus treated with sodium glucose cotransporter 2 inhibitors versus dipeptidyl peptidase-4 inhibitors

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Ann Wan-Chin Ling ◽  
Cze-Ci Chan ◽  
Shao-Wei Chen ◽  
Yi-Wei Kao ◽  
Chien-Ying Huang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lower Risk ◽  
Dipeptidyl Peptidase 4 ◽  
Sodium Glucose Cotransporter ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background Sodium glucose cotransporter 2 inhibitor (SGLT2i) reduces the risk of hard cardiovascular endpoints in type 2 diabetes mellitus (T2DM) patients with/without established cardiovascular diseases. Whether SGLT2i is associated with a lower risk of new-onset atrial fibrillation (AF) in T2DM patients is unclear. We aimed to evaluate the risk of new-onset AF associated with the use of SGLT2i compared to dipeptidyl peptidase-4 inhibitor (DPP4i) among a longitudinal cohort of diabetic patients. Methods We used medical data from a multi-center healthcare provider in Taiwan, which included a total of 15,606 and 12,383 patients treated with SGLT2i and DPP4i, respectively, from June 1, 2016 to December 31, 2018. We used propensity-score weighting to balance covariates across study groups. Patients were followed up from the drug index date until the occurrence of new-onset AF, discontinuation of the index drug, or the end of the study period, whichever occurred first. Results Overall, 55%, 45%, and 0% of the patients were treated with empagliflozin, dapagliflozin, and canagliflozin, respectively. Most patients in the DPP4i group were prescribed with linagliptin (51%), followed by sitagliptin (24%), saxagliptin (13%), vildagliptin (8%) and alogliptin (5%). The use of SGLT2i was associated with a lower risk of new-onset AF compared with DPP4i after propensity-score weighting [hazard ratio: 0.61; 95% confidential interval: 0.50–0.73; P < 0.001]. Subgroup analysis revealed that the use of SGLT2i was associated with a lower risk of new-onset AF compared with DPP4i across several subgroups including old age, female in gender, the presence of cardiovascular disease, hemoglobin A1c $$\ge$$ ≥ 8%, and chronic kidney disease. The advantage of SGLT2i over DPP4i persisted with different SGLT2i (dapagliflozin or empagliflozin) and either low- or standard-dose SGLT2i. Conclusions SGLT2i was associated with a lower risk of new-onset AF compared with DPP4i among T2DM patients in real-world practice.

scholarly journals Metformin Use is Associated with A Lower Incidence of Hospitalization for Atrial Fibrillation in Patients with Type 2 Diabetes Mellitus

2020 ◽  
Author(s):  
Chin-Hsiao Tseng
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Propensity Score ◽  
Sensitivity Analyses ◽  
Matched Cohort ◽  
Hazard Ratios ◽  
Incidence Of Hospitalization

Abstract Background: The effect of metformin on the risk of atrial fibrillation (AF) requires confirmation. This study compared the incidence of hospitalization for AF in ever and never users of metformin. Methods: Patients with newly diagnosed type 2 diabetes mellitus during 1999-2005 were enrolled from Taiwan’s National Health Insurance database. Analyses were conducted in both an unmatched cohort of 173398 ever users and 21666 never users and in a propensity score-matched cohort of 21647 pairs of ever and never users. They were free from a diagnosis of AF before January 1, 2006 and were followed up until December 31, 2011. Hazard ratios were estimated by Cox regression incorporated with the inverse probability of treatment weighting using the propensity score.Results: A total of 303 ever users and 86 never users in the unmatched cohort and 50 ever users and 86 never users in the matched cohort developed hospitalization for AF during follow-up. The respective incidence rates were 37.72 and 92.45 per 100,000 person-years in the unmatched cohort and were 50.71 and 92.52 per 100,000 person-years in the matched cohort. The hazard ratio for ever versus never users was 0.405 (95% confidence interval: 0.319-0.515) in the unmatched cohort and 0.548 (0.387-0.777) in the matched cohort. Hazard ratios for the tertiles of cumulative duration of metformin therapy versus never users showed a dose-response effect. The findings were consistent in sensitivity analyses.Conclusion: Metformin use is associated with a lower risk of hospitalization for AF in patients with type 2 diabetes mellitus.

scholarly journals Metformin Use Is Associated With a Lower Incidence of Hospitalization for Atrial Fibrillation in Patients With Type 2 Diabetes Mellitus

2021 ◽  
Vol 7 ◽  
Author(s):  
Chin-Hsiao Tseng
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Propensity Score ◽  
Sensitivity Analyses ◽  
Matched Cohort ◽  
Hazard Ratios ◽  
Incidence Of Hospitalization

Background: The effect of metformin on the risk of atrial fibrillation (AF) requires confirmation. This retrospective cohort study compared the incidence of hospitalization for AF in ever and never users of metformin.Methods: Patients with newly diagnosed type 2 diabetes mellitus during 1999–2005 were enrolled from Taiwan's National Health Insurance database. Analyses were conducted in both an unmatched cohort of 173,398 ever users and 21,666 never users and in a propensity score-matched cohort of 21,662 pairs of ever and never users. They were free from a diagnosis of AF before January 1, 2006 and were followed up until December 31, 2011. Hazard ratios were estimated by Cox regression incorporated with the inverse probability of treatment weighting using the propensity score.Results: A total of 303 ever users and 86 never users in the unmatched cohort and 56 ever users and 86 never users in the matched cohort developed hospitalization for AF during follow-up. The respective incidence rates were 37.72 and 92.45 per 100,000 person-years in the unmatched cohort and were 56.98 and 92.46 per 100,000 person-years in the matched cohort. The hazard ratio for ever vs. never users was 0.405 (95% confidence interval: 0.319–0.515) in the unmatched cohort and 0.617 (0.441–0.864) in the matched cohort. Hazard ratios for the tertiles of cumulative duration of metformin therapy vs. never users showed a dose-response effect. The findings were consistent in sensitivity analyses.Conclusion: Metformin use is associated with a lower risk of hospitalization for AF in patients with type 2 diabetes mellitus.

scholarly journals The risk of new-onset atrial fibrillation in patients with type 2 diabetes mellitus treated with sodium glucose cotransporter 2 inhibitors versus dipeptidyl peptidase-4 inhibitors

2020 ◽  
Author(s):  
Ann Wan-Chin Ling ◽  
Cze-Ci Chan ◽  
Shao-Wei Chen ◽  
Wei-Yi Kao ◽  
Chien-Ying Huang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Lower Risk ◽  
Dipeptidyl Peptidase 4 ◽  
Sodium Glucose Cotransporter ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Purpose: Sodium glucose cotransporter 2 inhibitor (SGLT2i) reduced the risk of hard cardiovascular endpoints in type 2 diabetes mellitus (T2DM) patients with/without established cardiovascular diseases. Whether SGLT2i is associated with a lower risk of new-onset atrial fibrillation (AF) in T2DM patients is unclear. We aimed to evaluate the risk of new-onset AF associated with the use of SGLT2i compared to dipeptidyl peptidase-4 inhibitors (DPP4i) among a longitudinal cohort of diabetic patients. Methods: We used medical data from a multi-center healthcare provider in Taiwan, which included a total of 21,480 and 22,989 patients treated with SGLT2i and DPP4i, respectively, from June 1, 2016 to December 31, 2018. We used propensity-score weighting to balance covariates across study groups. Patients were followed up from the drug index date until the occurrence of new-onset AF, discontinuation of the index drug, or the end of the study period, whichever occurred first. Results: Overall, 56%, 42%, and 2% of the patients were treated with empagliflozin, dapagliflozin, and canagliflozin, respectively. Most patients in the DPP4i group were prescribed with linagliptin (51%), followed by sitagliptin (24%), saxagliptin (13%), vildagliptin (8%) and alogliptin (4%). The use of SGLT2i was associated with a lower risk of new-onset AF compared with DPP4i after propensity-score weighting [adjusted hazard ratio: 0.69; 95% confidential interval: 0.64-0.74; P < 0.001]. Subgroup analysis revealed that the use of SGLT2i was associated with a lower risk of new-onset AF compared with DPP4i across several subgroups including old age, the presence of congestive heart failure, cardiovascular disease, overweight patients, hemoglobin A1c 8%, and chronic kidney disease. The advantage of SGLT2i over DPP4i persisted with different SGLT2i (dapagliflozin or empagliflozin) and either low- or standard-dose SGLT2i. Conclusions: SGLT2i was associated with a lower risk of new-onset AF compared with DPP4i among T2DM patients in real-world practice.

scholarly journals Chronic Metformin Therapy is Associated with a Lower Risk of Hemorrhoid in Patients with Type 2 Diabetes Mellitus

2021 ◽  
Vol 11 ◽  
Author(s):  
Chin-Hsiao Tseng
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lower Risk ◽  
Cox Regression ◽  
Hazard Ratio ◽  
Matched Cohort ◽  
Metformin Therapy ◽  
New Onset

Background: Metformin has anti-inflammatory property and reduces the risk of varicose vein in our previous study.Aim: To investigate the risk of hemorrhoid, another common disease involving the hemorrhoidal venous plexus, in ever vs. never users of metformin in patients with type 2 diabetes mellitus.Methods: This is a population-based retrospective cohort study. Patients with new-onset type 2 diabetes mellitus during 1999–2005 were enrolled from Taiwan’s National Health Insurance. All patients who were alive on January 1, 2006 were followed up until December 31, 2011. Analyses were conducted in both an unmatched cohort of 152,347 ever users and 19,523 never users and in 19,498 propensity score (PS)-matched pairs of ever and never users. Traditional Cox regression and Cox regression incorporated with the inverse probability of treatment weighting (IPTW) using the PS were used to estimate hazard ratios.Results: New-onset hemorrhoid was diagnosed in 8,211 ever users and 2025 never users in the unmatched cohort and in 1,089 ever users and 2022 never users in the matched cohort. The hazard ratio for ever vs. never users derived from the traditional Cox regression was 0.464 (95% confidence interval: 0.440–0.488) in the unmatched cohort; and was 0.488 (0.453–0.525) in the matched cohort. In the IPTW models, the hazard ratio was 0.464 (0.442–0.487) in the unmatched cohort and was 0.492 (0.457–0.530) in the matched cohort. A dose-response pattern was observed while comparing the tertiles of cumulative duration, cumulative dose and defined daily dose of metformin therapy to never users in all analyses. A risk reduction of approximately 40–50% was consistently observed in various sensitivity analyses.Conclusion: Chronic therapy with metformin in patients with type 2 diabetes mellitus is associated with a lower risk of hemorrhoid.

scholarly journals Role of CHA2DS2-VASc score in predicting new-onset atrial fibrillation in patients with type 2 diabetes mellitus with and without hyperosmolar hyperglycaemic state: real-world data from a nationwide cohort

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020065 ◽  
Author(s):  
Wei-Syun Hu ◽  
Cheng-Li Lin
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Predictive Ability ◽  
Type 2 Dm ◽  
History Of ◽  
New Onset

PurposeThe objective of the current study was to explore the role of CHA2DS2-VASc score in predicting incidence of atrial fibrillation (AF) in patients with type 2 diabetes mellitus (DM). Furthermore, the use of the CHA2DS2-VASc score for stratifying new-onset AF risk in patients with DM and with/without hyperosmolar hyperglycaemic state (HHS) was also compared.MethodsThe study subjects were identified from Longitudinal Health Insurance Database provided by the National Health Research Institutes. The patients with DM were divided into two groups based on a history of HHS or not. The predictive ability of CHA2DS2-VASc score for stratifying new-onset AF risk in the two groups was calculated using the area under the curve of receiver-operating characteristic (AUROC).ResultsThe present study involved a total of 69 530 patients with type 2 DM. Among them, 1558 patients had a history of HHS, whereas 67 972 patients did not. The AUROC of the CHA2DS2-VASc score as a predictor of incident AF in patients with DM and with/without HHS was 0.67 (95% CI 0.59 to 0.75) and 0.71 (95% CI 0.70 to 0.72), respectively.ConclusionsTo conclude, we reported for the first time on the assessment of CHA2DS2-VASc score for incident AF risk discrimination in patients with type 2 DM. We further found that the predictive ability of the CHA2DS2-VASc score was attenuated in patients with type 2 DM and with HHS in comparison with those without HHS.

scholarly journals The impact of weight loss related to risk of new-onset atrial fibrillation in patients with type 2 diabetes mellitus treated with sodium–glucose cotransporter 2 inhibitor

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yi-Hsin Chan ◽  
Shao-Wei Chen ◽  
Tze-Fan Chao ◽  
Yi-Wei Kao ◽  
Chien-Ying Huang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Sodium Glucose Cotransporter ◽  
The Impact ◽  
Baseline Bmi ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background Sodium–glucose cotransporter 2 inhibitor (SGLT2i) use reduces body weight (BW) in patients with type 2 diabetes mellitus (T2DM). Obesity and T2DM are strong risk factors of new-onset atrial fibrillation (AF). However, whether BW loss following SGLT2i treatment reduces AF risk in patients with T2DM remains unclear. Methods We used a medical database from a multicenter health care provider in Taiwan, which included 10,237 patients with T2DM, from June 1, 2016 to December 31, 2018, whose BW data at baseline and at 12 weeks of SGLT2i treatment were available. Patients were followed up from the drug index date until the occurrence of new-onset AF, discontinuation of the SGLT2i, or the end of the study period, whichever occurred first. Results The patients’ baseline body mass index (BMI) was 28.08 $$\pm$$ ± 4.88 kg/m2. SGLT2i treatment was associated with a BW loss of 1.35 $$\pm$$ ± 3.28 kg (1.78%$$\pm$$ ± 4.47%). There were 37.4%, 47.0%, and 15.6% of patients experienced no-BW loss (n = 3832), BW loss 0.0–4.9% (n = 4814), and $$\ge$$ ≥ 5.0% (n = 1591) following SGLT2i treatment, respectively. Compared with patients with baseline BMI < 23 kg/m2, AF risk significantly increased in patients with baseline BMI $$\ge$$ ≥ 27.5 kg/m2 (P for trend = 0.015). Compared with those without BW loss after SGLT2i treatment, AF risk significantly decreased with a BW loss of $$\ge$$ ≥ 5.0% (adjusted hazard ratios [95% confidence intervals]: 0.39[0.22–0.68]). Use of diuretics, old age, high-dose SGLT2i, higher estimated glomerular filtration rate, and baseline BMI were independent factors associated with a BW loss of $$\ge$$ ≥ 5.0% following SGLT2i initiation. By contrast, neither baseline BMI nor BW loss after SGLT2i treatment predicted major cardiovascular adverse events or heart failure hospitalization risk (P for trend > 0.05). Conclusion BW loss of ≥ 5.0% following SGLT2i treatment was associated with a lower risk of new-onset AF in patients with T2DM in real-world practice.

scholarly journals Sarcopenia Is Associated With a Risk of Mortality in People With Type 2 Diabetes Mellitus

2021 ◽  
Vol 12 ◽  
Author(s):  
Fuyuko Takahashi ◽  
Yoshitaka Hashimoto ◽  
Ayumi Kaji ◽  
Ryosuke Sakai ◽  
Takuro Okamura ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Muscle Strength ◽  
Propensity Score ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
History Of

BackgroundSarcopenia has reportedly been associated with increased risk of mortality in general populations. However, few studies have investigated the association between sarcopenia and mortality in older people with type 2 diabetes mellitus (T2D). This study aimed to investigate the effect of sarcopenia on incident all-cause mortality in older people with T2D.MethodsLow muscle strength were set at handgrip strength &lt;28 kg for men and &lt;18 kg for women, and low skeletal muscle mass index (SMI), evaluated using the impedance body composition analyzer, were set at SMI &lt;7.0 kg/m2 for men and &lt;5.7 kg/m2 for women. People who had both low muscle strength and low SMI were diagnosed with sarcopenia. Due to a low incidence of all-cause mortality, the propensity score was used. The propensity score was evaluated using multivariable logistic regression models with the following parameters: age, sex, duration of diabetes, history of heart disease, history of cancer, smoking, exercise, alcohol, sodium-glucose cotransporter-2 inhibitor, glucagon-like peptide-1 receptor agonist, insulin, corticosteroid, hypertension, body mass index, glycosylated hemoglobin A1c, triglycerides, and creatinine, and the C-statistic was 0.89.ResultsIn this prospective cohort study, 396 people with an average age and duration of diabetes of 71.3 (6.3) years and 16.3 (11.3) years, respectively, were included. Of those included, 14.6% had sarcopenia. During the average 40.5 (16.5) months of follow-up, 13 people (6 out of the 338 without sarcopenia and 7 out of the 58 with sarcopenia) died. Incident rate were 5.1/1000 person years of follow-up in people without sarcopenia and 41.3/1000 person years of follow-up in people with sarcopenia. According to Cox regression analysis, sarcopenia was associated with all-cause mortality (adjusted hazard ratio: 6.12, 95% confidence interval: 1.52–24.7, p = 0.011).ConclusionSarcopenia is associated with incident all-cause mortality in older outpatients with T2D.

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