SGLT2 inhibitors in comparison to sulphonylureas (SUs) - comparison of all-cause mortality

Last edited 07/2021 and last reviewed 07/2021

A study was undertaken to evaluate the comparative effectiveness of SGLT2 inhibitors and sulfonylureas associated with the risk of all-cause mortality among patients with type 2 diabetes using metformin

• a cohort study used data from the US Department of Veterans Affairs compared the use of SGLT2 inhibitors vs sulfonylureas in individuals receiving metformin for treatment of type 2 diabetes
• a total of 23870 individuals with new use of SGLT2 inhibitors and 104423 individuals with new use of sulfonylureas were enrolled between October 1, 2016, and February 29, 2020, and followed up until January 31, 2021

Study results

• study (n=128,293 on metformin) found use of SGLT2 inhibitors linked to reduced risk of all-cause mortality compared with sulfonylureas (HR, 0.81; 95% CI, 0.75-0.87), regardless of CVD status, estimated glomerular filtration rate category, and albuminuria status

Conclusions:

• results of this study suggest that, compared with sulfonylureas, SGLT2 inhibitor use was associated with reduced risk of all-cause mortality among individuals using metformin for treatment of type 2 diabetes
  • association was evident in those with and without cardiovascular disease, regardless of eGFR category and albuminuria status, and in several other prespecified subgroups.
  • analyses suggested that combined use of SGLT2 inhibitors and metformin was associated with reduced risk of all-cause mortality compared with SGLT2 inhibitors alone
  • results provide real-world evidence on the association of SGLT2 inhibitor use with the risk of all-cause death; the results may help guide the choice of antihyperglycemic therapy in people with type 2 diabetes

Reference:

• Xie Y, Bowe B, Gibson AK, McGill JB, Maddukuri G, Al-Aly Z. Comparative Effectiveness of Sodium-Glucose Cotransporter 2 Inhibitors vs Sulfonylureas in Patients With Type 2 Diabetes. JAMA Intern Med. Published online June 28, 2021. doi:10.1001/jamainternmed.2021.2488