<b>Objective</b>: Both SGLT2 inhibitors (SGLT2i) and
GLP-1 receptor agonists (GLP-1RA) demonstrated cardiovascular benefits in RCTs of
patients with type 2 diabetes (T2D) generally <65 years and mostly with cardiovascular disease (CVD). We
aimed to evaluate the comparative effectiveness and safety of SGLT2 inhibitors (SGLT2i) and GLP-1 receptor
agonists (GLP-1RA) among real-world older adults.
<p><b>Methods</b>: Using Medicare data (4/2013-12/2016), we
identified 90,094 1:1 propensity score-matched T2D patients ≥66 years
initiating SGLT2i or GLP-1RA. Primary outcomes were major adverse
cardiovascular events (MACE, i.e., myocardial infarction, stroke or
cardiovascular death) and hospitalization for heart failure (HHF). Other outcomes
included diabetic ketoacidosis (DKA), genital infections (GI), fractures,
lower-limb amputations (LLA), acute kidney injury (AKI), severe urinary tract
infections (UTI), and overall mortality. We estimated hazard ratios (HR) and rate
differences (RD) per 1000 person-years, controlling for 140 baseline
covariates. </p>
<p><a><b>Results</b></a>: Compared with GLP-1RA, SGLT2i initiators
had similar MACE risk [HR (95% CI)=0.98 (0.87-1.10); RD (95% CI)= -0.38 (-2.48,1.72)]
and reduced HHF risk [HR=0.68 (0.57-0.80)]; RD= -3.23 (-4.68,-1.77)], over a
median follow up of approximately 6 months. They also had 0.7 [RD=0.72 (0.02,
1.41)] more DKA, 0.9 [RD=0.90 (0.10, 1.70)] more LLA, 57.1 [RD=57.08 (53.45,
60.70)] more GI, and 7.1 [RD=-7.05 (-10.27, -3.83)] fewer AKI events. </p>
<p><b>Conclusions</b>: Among older adults, SGLT2i had
similar MACE risk, decreased HHF risk, and increased risk of DKA, LLA, and GI, vs.
GLP-1RA. </p>