AIM To assess the comparative effects of sodium-glucose co-transporter-2 (SGLT2) inhibitors, sulphonylureas (SUs) and dipeptidyl peptidase-4 (DPP-4) inhibitors on cardiometabolic risk factors in routine care. MATERIALS AND METHODS Using primary care data on 10 631 new users of SUs, SGLT2 inhibitors or DPP-4 inhibitors added to metformin, obtained from the UK Clinical Practice Research Datalink, we created propensity-score matched cohorts and used linear mixed models to describe changes in glycated haemoglobin (HbA1c), estimated glomerular filtration rate (eGFR), systolic blood pressure (BP) and body mass index (BMI) over 96 weeks. RESULTS HbA1c levels fell substantially after treatment intensification for all drugs: mean change at week 12: SGLT2 inhibitors: -15.2 mmol/mol (95% confidence interval [CI] -16.9, -13.5); SUs: -14.3 mmol/mol (95% CI -15.5, -13.2); and DPP-4 inhibitors: -11.9 mmol/mol (95% CI -13.1, -10.6). Systolic BP fell for SGLT2 inhibitor users throughout follow-up, but not for DPP-4 inhibitor or SU users: mean change at week 12: SGLT2 inhibitors: -2.3 mmHg (95% CI -3.8, -0.8); SUs: -0.8 mmHg (95% CI -1.9, +0.4); and DPP-4 inhibitors: -0.9 mmHg (95% CI -2.1,+0.2). BMI decreased for SGLT2 inhibitor and DPP-4 inhibitor users, but not SU users: mean change at week 12: SGLT2 inhibitors: -0.7 kg/m2 (95% CI -0.9, -0.5); SUs: 0.0 kg/m2 (95% CI -0.3, +0.2); and DPP-4 inhibitors: -0.3 kg/m2 (95% CI -0.5, -0.1). eGFR fell at 12 weeks for SGLT2 inhibitor and DPP-4 inhibitor users. At 60 weeks, the fall in eGFR from baseline was similar for each drug class. CONCLUSIONS In routine care, SGLT2 inhibitors had greater effects on cardiometabolic risk factors than SUs. Routine care data closely replicated the effects of diabetes drugs on physiological variables measured in clinical trials.

中文翻译：

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磺脲类药物、二肽基肽酶 4 抑制剂和钠-葡萄糖协同转运蛋白 2 抑制剂加入二甲双胍单药治疗的比较效果：英国初级保健的倾向评分匹配队列研究。

目的 评估钠-葡萄糖协同转运蛋白 2 (SGLT2) 抑制剂、磺脲类 (SUs) 和二肽基肽酶 4 (DPP-4) 抑制剂对常规护理中心脏代谢危险因素的比较影响。材料和方法 使用来自英国临床实践研究数据链的 10 631 名 SU、SGLT2 抑制剂或 DPP-4 抑制剂新用户的初级保健数据，我们创建了倾向得分匹配队列并使用线性混合模型来描述变化96 周内的糖化血红蛋白 (HbA1c)、估计的肾小球滤过率 (eGFR)、收缩压 (BP) 和体重指数 (BMI)。结果 所有药物的强化治疗后 HbA1c 水平显着下降：第 12 周的平均变化：SGLT2 抑制剂：-15.2 mmol/mol（95% 置信区间 [CI] -16.9，-13.5）；苏：-14。3 毫摩尔/摩尔（95% CI -15.5，-13.2）；和 DPP-4 抑制剂：-11.9 mmol/mol (95% CI -13.1, -10.6)。在整个随访过程中，SGLT2 抑制剂使用者的收缩压下降，但 DPP-4 抑制剂或 SU 使用者没有：第 12 周的平均变化：SGLT2 抑制剂：-2.3 mmHg（95% CI -3.8，-0.8）；SU：-0.8 毫米汞柱（95% CI -1.9，+0.4）；和 DPP-4 抑制剂：-0.9 mmHg (95% CI -2.1,+0.2)。SGLT2 抑制剂和 DPP-4 抑制剂使用者的 BMI 下降，但 SU 使用者没有：第 12 周的平均变化：SGLT2 抑制剂：-0.7 kg/m2（95% CI -0.9，-0.5）；SU：0.0 kg/m2 (95% CI -0.3, +0.2)；和 DPP-4 抑制剂：-0.3 kg/m2 (95% CI -0.5, -0.1)。SGLT2 抑制剂和 DPP-4 抑制剂使用者的 eGFR 在 12 周下降。在 60 周时，每种药物类别的 eGFR 从基线的下降是相似的。结论 在常规护理中，SGLT2 抑制剂对心脏代谢危险因素的影响大于 SU。