Aims

This study aimed to compare cardiovascular benefits associated with the use of GLP-1RA versus SGLT2i as add-on therapies to metformin among adults with type 2 diabetes (T2D) with and without a history of cardiovascular complications, using real-world data.

Methods

Using data from the IBM® MarketScan® Commercial Claims Databases, metformin users above 18 years with T2D who initiated GLP-1RA or SGLT2i were identified. The study endpoints include MI, stroke, CHF, and a cardiovascular composite of these three outcomes. Cox proportional hazard regression models were used to compare the risks of cardiovascular endpoints while controlling for demographics and clinical characteristics.

Results

We identified 13,006 adults with T2D who initiated a GLP-1RA or SGLT2i as an add-on therapy to metformin and followed for a maximum of 5 years. No difference in the endpoints was observed between users of two drugs who did not have established cardiovascular disease at baseline. However, significantly lower CHF risks (HR: 0.47, 95% CI: 0.28–0.79) and cardiovascular composite (HR: 0.67, 95% CI: 0.47–0.97) were observed in SGLT2i users compared with GLP-1RA users, among individuals with established cardiovascular diseases.

Conclusions

Results suggest greater cardioprotective benefit from SGLT2i compared to GLP-1RA when used for secondary prevention among adults with T2D.

中文翻译：

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比较 GLP-1 受体激动剂和 SGLT2 抑制剂作为二甲双胍对 2 型糖尿病患者的心血管益处：一项回顾性队列研究

目标

本研究旨在使用真实世界的数据，在有和没有心血管并发症史的 2 型糖尿病 (T2D) 成人患者中比较使用 GLP-1RA 与 SGLT2i 作为二甲双胍附加疗法相关的心血管益处。

方法

使用来自 IBM® MarketScan® Commercial Claims Databases 的数据， 确定了启动 GLP-1RA 或 SGLT2i 的 18 岁以上患有 T2D 的二甲双胍用户。研究终点包括 MI、中风、CHF 和这三个结果的心血管复合物。Cox 比例风险回归模型用于比较心血管终点的风险，同时控制人口统计学和临床​​特征。

结果

我们确定了 13,006 名 T2D 成人，他们启动了 GLP-1RA 或 SGLT2i 作为二甲双胍的附加疗法，并随访最长 5 年。在基线时未确诊心血管疾病的两种药物使用者之间未观察到终点差异。然而，与 GLP-1RA 使用者相比，SGLT2i 使用者的 CHF 风险（HR：0.47，95% CI：0.28-0.79）和心血管复合材料（HR：0.67，95% CI：0.47-0.97）显着降低。确定的心血管疾病。

结论

结果表明，当用于成人 T2D 的二级预防时，SGLT2i 与 GLP-1RA 相比具有更大的心脏保护益处。