The effect of sodium‐glucose cotransporter 2 inhibitors on HbA1c variability and cardiovascular and renal adverse outcome in patients with T2DM
Year: 2025
Type: article
Study design: Observational Study
Abstract: AIMS: To compare the effectiveness of sodium-glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase 4 (DPP-4) inhibitors in reducing haemoglobin A1c (HbA1c) variability and improving cardiovascular and renal outcomes in patients with type 2 diabetes mellitus (T2DM) and high HbA1c variability. METHODS: This territory-wide cohort study involved patients with T2DM and an HbA1c variability score (HVS) >60% who initiated SGLT2 inhibitors or DPP-4 inhibitors in Hong Kong between 2015 and 2022. Propensity score (PS) matching was used to adjust for confounders. The primary outcome was post-treatment HVS within 3 years. Secondary outcomes included major adverse cardiovascular events (MACE) and serious renal events (SRE). RESULTS: Among 20,205 T2DM patients with a baseline HVS >60%, 4,612 SGLT2 inhibitor users were 1:1 matched with DPP-4 inhibitor users. When referencing the 0%-20% quintile, patients initiating SGLT2 inhibitors versus DPP-4 inhibitors exhibited a reduced likelihood of being in higher HVS quintiles [21%-40%: odds ratio (OR) 0.76, 95% confidence interval (CI) 0.66-0.88; 41%-60%: OR 0.57, 95% CI 0.50-0.65; 61%-80%: OR 0.49, 95% CI 0.42-0.56; and 81%-100%: OR 0.40, 95% CI 0.34-0.47]. SGLT2 inhibitors were associated with a reduced risk of MACE [hazard ratio (HR) 0.69; 95% CI 0.60-0.79] and SRE (HR 0.71; 95% CI 0.63-0.80) compared to DPP-4 inhibitors. CONCLUSION: In patients with high HbA1c variability, SGLT2 inhibitor initiation was associated with superior effectiveness in reducing HbA1c variability compared to DPP-4 inhibitors. The initiation of SGLT2 inhibitors versus DPP-4 inhibitors was linked to significantly reduced cardiovascular and renal adverse events.
Source: Diabetes Obesity and Metabolism
DOI: 10.1111/dom.16509
Authors: Ran Guo, Ambarish Pandey, Chanchal Chandramouli, Mei‐Zhen Wu, An‐Ping Cai, Ying‐Xian Liu, Qing‐Wen Ren, Jia‐Yi Huang, Jing‐Nan Zhang, Wen‐Li Gu, Hao‐Chen Xuan, Wouter Ouwerkerk, Jasper Tromp, Tiew‐Hwa Katherine Teng, Christopher Tze‐Wei Tsang, Ching‐Yan Zhu, Yik‐Ming Hung, Carolyn S. P. Lam, Kai‐Hang Yiu
Institutions: Queen Mary Hospital, University of Hong Kong - Shenzhen Hospital, University of Hong Kong, The University of Texas Southwestern Medical Center, National University of Singapore, Duke-NUS Medical School, National Heart Centre Singapore, Guangzhou First People's Hospital, South China University of Technology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Southern Medical University, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Amsterdam University Medical Centers, University of Amsterdam, University Medical Center Groningen, University of Groningen, National University Health System, Baim Institute for Clinical Research
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,380
OpenAlex ID: W4411285215