Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyMay 2023
Apparently not, according to an observational study.
Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are used to manage type 2 diabetes but also have protective cardiovascular and renal effects. Because SGLT-2 inhibitors induce glucosuria, they are associated with volume depletion, mycotic urinary tract infections and diabetic ketoacidosis. Do these benefits and adverse effects vary according to baseline level of hyperglycaemia? To find out, researchers conducted a retrospective study of 145,000 commercially insured patients (mean age, 62 years) with type 2 diabetes, categorised by baseline glycosylated haemoglobin (HbA1c) levels.
Patients who began using SGLT-2 inhibitors were compared with propensity-score-matched patients who initiated dipeptidyl peptidase-4 (DPP-4) inhibitors, within three categories of HbA1c: below 58 mmol/mol (7.5%), 58 to 75 mmol/mol (7.5% to 9%) and above 75 mmol/mol (9%). (DPP-4 inhibitor users served as controls, because that drug class is not associated with the specific benefits or adverse effects of SGLT-2 inhibitors.) After mean follow up of eight months, initiation of SGLT-2 inhibitors was associated with significantly lower risks for major adverse cardiovascular events and hospitalisation for heart failure, and with higher risks for genital infections and diabetic ketoacidosis – regardless of baseline HbA1c level.
Comment: This study suggests that the unique benefits and adverse effects of SGLT-2 inhibitors do not vary by degree of glycaemic control. If the goal is cardiovascular protection, baseline HbA1c need not influence the decision to start these drugs.
Paul S. Mueller, MD, MPH, FACP, Regional Vice President – Southwest Wisconsin, Mayo Clinic Health System, La Crosse; Professor of Medicine and Biomedical Ethics, Mayo Clinic College of Medicine and Science, Rochester, USA.
D’Andrea E, et al. Comparing effectiveness and safety of SGLT2 inhibitors vs DPP-4 inhibitors in patients with type 2 diabetes and varying baseline HbA1c levels. JAMA Intern Med 2023; 183: 242-254.
This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine.