Soluble dipeptidyl peptidase-4 activity is associated with decreased renal function in patients with type 2 diabetes

Background:The risk of psoriasis in diabetic patients has rarely been explored.Objectives:This study aimed to investigate the association between dipeptidyl peptidase-4 (DPP4) inhibitors and the risk of psoriasis in type 2 diabetes mellitus (T2DM) patients.Methods:We conducted a population-based propensity score-matched cohort study on the basis of Taiwan’s National Health Insurance Research Database that included initiators of combination therapy with DPP4i (DPP4i plus metformin) and sulfonylurea (sulfonylurea plus metformin). Psoriasis (PSO) was identified with ≥2 diagnoses. Diabetes complications severity index (DCSI) was calculated. A total of 22721 DPP4 initiator and 227684 sulfonylurea initiator were identified. A 1:10 matched-pair cohort based on propensity score(PS) was created. PS-stratified Cox proportional hazards models compared the risk of PSO in DPP4i versus sulfonylurea initiator within 2 years, controlling for potential confounders.Results:After propensity score matching, 9962 patients with T2DM starting DPP4i combination therapy and 39848 starting sulfonylurea combination therapy were selected. The incidence rate of PSO was lower in DPP4i group (188/100000 person- years) than in sulfonylurea group (467/100000 person-years). Risks of incident psoriasis were significantly lower in the DPP4i group versus sulfonylurea with the PS-stratified HR of 0.422 (95% CI 0.273 to 0.716).Conclusion:DPP4i plus metformin was associated with a reduced risk of psoriasis than sulfonylurea plus metformin. These findings merit further investigation.Disclosure of Interests:None declared

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Risk of morbidity and mortality in patients with type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitor and/or dipeptidyl peptidase-4 inhibitor: a nationwide study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001765 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001765

Author(s):

Gábor Sütő ◽

Gergő A Molnár ◽

Gyorgy Rokszin ◽

Ibolya Fábián ◽

Zoltan Kiss ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Propensity Score ◽

Propensity Score Matching ◽

Dipeptidyl Peptidase ◽

Dipeptidyl Peptidase 4 ◽

Sodium Glucose Cotransporter ◽

Dipeptidyl Peptidase 4 Inhibitor ◽

All Cause Mortality

IntroductionMortality and disability in diabetes mellitus are determined mostly by cardiovascular complications and cancer. The impact of dipeptidyl peptidase-4 inhibitor (DPP-4i) and sodium-glucose cotransporter-2 inhibitor (SGLT2i) monotherapy or combination on long-term complications of type 2 diabetes mellitus was studied.Research design and methodsPatients with type 2 diabetes treated with DPP-4i or SGLT2i during a 3-year period were identified in the database of the National Institute of Health Insurance Fund in Hungary. All-cause mortality, acute myocardial infarction, stroke, hospitalization for heart failure (HHF), lower limb amputation (LLA) and cancer were assessed. Outcomes of add-on SGLT2i to DPP-4i treatment in comparison with switching DPP-4i therapy to SGLT2i were also evaluated. After propensity score matching, survival analysis was performed with a Cox proportional hazards model.ResultsAfter propensity score matching, both SGLT2i and DPP-4i groups included 18 583 patients. All-cause mortality (HR, 0.80; 95% CI 0.68 to 0.94; p=0.0057), HHF (HR, 0.81; 95% CI 0.71 to 0.92; p=0.0018), and risk of cancer (HR, 0.75; 95% CI 0.66 to 0.86; p<0.0001) were lower in the SGLT2i population compared with DPP-4i. Risk of LLA was higher in the SGLT2i group (HR, 1.35; 95% CI 1.03 to 1.77; p=0.0315). SGLT2i in combination with DPP-4i results in lower all-cause mortality (HR, 0.46; 95% CI 0.31 to 0.67; p=0.0001), with a lower trend in stroke, LLA, HHF and cancer, but without any statistical difference.ConclusionsSGLT2i treatment leads to a lower risk of overall mortality, HHF and cancer when compared with DPP-4i treatment. Adding SGLT2i to DPP-4i instead of switching from DPP-4i to SGLT2i further lowers the risk of all-cause mortality.

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