Effect of frailty on effectiveness and safety of GLP-1 receptor agonists versus SGLT2 inhibitors in people with type 2 diabetes in Taiwan: a retrospective, nationwide, longitudinal study

IF 13.4 Q1 GERIATRICS & GERONTOLOGY
{"title":"Effect of frailty on effectiveness and safety of GLP-1 receptor agonists versus SGLT2 inhibitors in people with type 2 diabetes in Taiwan: a retrospective, nationwide, longitudinal study","authors":"","doi":"10.1016/j.lanhl.2024.07.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>GLP-1 receptor agonists and SGLT2 inhibitors are increasingly being used in people with type 2 diabetes on the basis of findings from randomised clinical trials; however, little is known of whether clinical outcomes are affected by frailty in real-world settings. We aimed to compare the clinical effectiveness and safety of GLP-1 receptor agonists and SGLT2 inhibitors in managing type 2 diabetes, with a specific focus on stratifying people by their frailty status.</p></div><div><h3>Methods</h3><p>In this retrospective, nationwide, longitudinal study, we identified people (aged ≥20 years) with type 2 diabetes who newly initiated either a GLP-1 receptor agonist or an SGLT2 inhibitor during the period Jan 1, 2017 to Dec 31, 2019 from the Taiwan National Health Insurance database. Individuals were excluded if they had been diagnosed with cancer, received dialysis for kidney failure, or had prescriptions for a GLP-1 receptor agonist or an SGLT2 inhibitor, within 1 year before the index date. Mortality data were collected from the Taiwan National Death Registry. Eligible individuals were categorised into three frailty subgroups—fit, mild frailty, and moderate or severe frailty—on the basis of the multimorbidity frailty index. Propensity score matching (1:1) was used to balance covariates between recipients of GLP-1 receptor agonists and SGLT2 inhibitors among each frailty subgroup. Clinical outcomes of interest included three-point major adverse cardiovascular events (non-fatal acute myocardial infarction, non-fatal stroke, and fatal cardiovascular disease), all-cause mortality, hospitalisation for heart failure, dialysis or renal transplant, severe diabetic foot complications, retinopathy, hospitalisation for severe hyperglycaemia, and hospitalisation for severe hypoglycaemia. The association between the use of a GLP-1 receptor agonist versus an SGLT2 inhibitor and the risk of the outcomes of interest among each frailty subgroup was examined using a subdistribution hazard model.</p></div><div><h3>Findings</h3><p>We identified 320 210 people with type 2 diabetes, of whom 280 163 met the eligibility criteria, who initiated either a GLP-1 receptor agonist (n=22 968; mean age 57·7 years [SD 13·9], 11 338 [49·4%] were female, and 11 630 [50·6%] were male) or SGLT2 inhibitor (n=257 195; mean age 58·8 years [12·3], 107 988 [42·0%] were female, and 149 207 [58·0%] were male) during 2017–19. After matching, 11 882, 7210, and 3414 pairs of GLP-1 receptor agonist and SGLT2 inhibitor users were assigned in the fit, mild frailty, and moderate or severe frailty subgroups. All clinical outcomes were comparable between users of GLP-1 receptor agonists and SGLT2 inhibitors among each frailty subgroup, except for a higher risk of hospitalisation for severe hyperglycaemia with GLP-1 receptor agonists than with SGLT2 inhibitors in the mild frailty subgroup (subdistribution hazard ratio 1·25 [95% CI 1·13–1·38]; p&lt;0·0001) and a higher risk of dialysis or renal transplant with GLP-1 receptor agonists than with SGLT2 inhibitors in the fit (2·43 [1·82–3·23]; p&lt;0·0001), mild frailty (3·93 [3·03 –5·09]; p&lt;0·0001), and moderate or severe frailty (2·60 [2·03–3·31]; p&lt;0·0001) subgroups.</p></div><div><h3>Interpretation</h3><p>Formulating clear and updated guidelines on the use of GLP-1 receptor agonists and SGLT2 inhibitors according to frailty status could improve management of type 2 diabetes.</p></div><div><h3>Funding</h3><p>Ministry of Education, Taiwan.</p></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":null,"pages":null},"PeriodicalIF":13.4000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824001375/pdfft?md5=e893d77bc3881c4e4d26dc5179146936&pid=1-s2.0-S2666756824001375-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Healthy Longevity","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666756824001375","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background

GLP-1 receptor agonists and SGLT2 inhibitors are increasingly being used in people with type 2 diabetes on the basis of findings from randomised clinical trials; however, little is known of whether clinical outcomes are affected by frailty in real-world settings. We aimed to compare the clinical effectiveness and safety of GLP-1 receptor agonists and SGLT2 inhibitors in managing type 2 diabetes, with a specific focus on stratifying people by their frailty status.

Methods

In this retrospective, nationwide, longitudinal study, we identified people (aged ≥20 years) with type 2 diabetes who newly initiated either a GLP-1 receptor agonist or an SGLT2 inhibitor during the period Jan 1, 2017 to Dec 31, 2019 from the Taiwan National Health Insurance database. Individuals were excluded if they had been diagnosed with cancer, received dialysis for kidney failure, or had prescriptions for a GLP-1 receptor agonist or an SGLT2 inhibitor, within 1 year before the index date. Mortality data were collected from the Taiwan National Death Registry. Eligible individuals were categorised into three frailty subgroups—fit, mild frailty, and moderate or severe frailty—on the basis of the multimorbidity frailty index. Propensity score matching (1:1) was used to balance covariates between recipients of GLP-1 receptor agonists and SGLT2 inhibitors among each frailty subgroup. Clinical outcomes of interest included three-point major adverse cardiovascular events (non-fatal acute myocardial infarction, non-fatal stroke, and fatal cardiovascular disease), all-cause mortality, hospitalisation for heart failure, dialysis or renal transplant, severe diabetic foot complications, retinopathy, hospitalisation for severe hyperglycaemia, and hospitalisation for severe hypoglycaemia. The association between the use of a GLP-1 receptor agonist versus an SGLT2 inhibitor and the risk of the outcomes of interest among each frailty subgroup was examined using a subdistribution hazard model.

Findings

We identified 320 210 people with type 2 diabetes, of whom 280 163 met the eligibility criteria, who initiated either a GLP-1 receptor agonist (n=22 968; mean age 57·7 years [SD 13·9], 11 338 [49·4%] were female, and 11 630 [50·6%] were male) or SGLT2 inhibitor (n=257 195; mean age 58·8 years [12·3], 107 988 [42·0%] were female, and 149 207 [58·0%] were male) during 2017–19. After matching, 11 882, 7210, and 3414 pairs of GLP-1 receptor agonist and SGLT2 inhibitor users were assigned in the fit, mild frailty, and moderate or severe frailty subgroups. All clinical outcomes were comparable between users of GLP-1 receptor agonists and SGLT2 inhibitors among each frailty subgroup, except for a higher risk of hospitalisation for severe hyperglycaemia with GLP-1 receptor agonists than with SGLT2 inhibitors in the mild frailty subgroup (subdistribution hazard ratio 1·25 [95% CI 1·13–1·38]; p<0·0001) and a higher risk of dialysis or renal transplant with GLP-1 receptor agonists than with SGLT2 inhibitors in the fit (2·43 [1·82–3·23]; p<0·0001), mild frailty (3·93 [3·03 –5·09]; p<0·0001), and moderate or severe frailty (2·60 [2·03–3·31]; p<0·0001) subgroups.

Interpretation

Formulating clear and updated guidelines on the use of GLP-1 receptor agonists and SGLT2 inhibitors according to frailty status could improve management of type 2 diabetes.

Funding

Ministry of Education, Taiwan.

台湾 2 型糖尿病患者体弱对 GLP-1 受体激动剂与 SGLT2 抑制剂有效性和安全性的影响:一项全国范围的回顾性纵向研究
背景根据随机临床试验的结果,GLP-1 受体激动剂和 SGLT2 抑制剂正越来越多地用于 2 型糖尿病患者;然而,在现实世界中,临床结果是否会受到体弱的影响却鲜为人知。我们的目的是比较 GLP-1 受体激动剂和 SGLT2 抑制剂在控制 2 型糖尿病方面的临床有效性和安全性,特别关注根据虚弱状况对患者进行分层。方法在这项回顾性、全国范围的纵向研究中,我们从台湾国民健康保险数据库中识别了在 2017 年 1 月 1 日至 2019 年 12 月 31 日期间新开始使用 GLP-1 受体激动剂或 SGLT2 抑制剂的 2 型糖尿病患者(年龄≥20 岁)。如果患者在指标日期前一年内被诊断出患有癌症、因肾衰竭而接受透析治疗,或有GLP-1受体激动剂或SGLT2抑制剂处方,则排除在外。死亡率数据来自台湾国家死亡登记处。根据多病虚弱指数,将符合条件的患者分为三个虚弱亚组--适合、轻度虚弱、中度或重度虚弱。采用倾向得分匹配法(1:1)平衡各虚弱亚组中 GLP-1 受体激动剂和 SGLT2 抑制剂接受者之间的协变量。相关临床结果包括三点主要不良心血管事件(非致死性急性心肌梗死、非致死性中风和致死性心血管疾病)、全因死亡率、心力衰竭住院、透析或肾移植、严重糖尿病足并发症、视网膜病变、严重高血糖住院和严重低血糖住院。使用亚分布危险模型研究了使用 GLP-1 受体激动剂与 SGLT2 抑制剂之间的关系,以及每个虚弱亚组中出现相关结果的风险。研究结果我们确定了320 210名2型糖尿病患者,其中280 163人符合资格标准,他们在2017-19年间开始使用GLP-1受体激动剂(n=22 968;平均年龄57-7岁[SD 13-9],女性11 338人[49-4%],男性11 630人[50-6%])或SGLT2抑制剂(n=257 195;平均年龄58-8岁[12-3],女性107 988人[42-0%],男性149 207人[58-0%])。配对后,11 882、7210 和 3414 对 GLP-1 受体激动剂和 SGLT2 抑制剂使用者被分配到体质良好、轻度虚弱和中度或重度虚弱亚组。在各虚弱亚组中,GLP-1 受体激动剂和 SGLT2 抑制剂使用者的所有临床结果均相当,但在轻度虚弱亚组中,GLP-1 受体激动剂使用者因严重高血糖住院的风险高于 SGLT2 抑制剂使用者(亚组危险比 1-25 [95% CI 1-13-1-38];p<0-0001),在体格健壮(2-43 [1-82-3-23]; p<0-0001)、轻度虚弱(3-93 [3-03-5-09]; p<0-0001)和中度或重度虚弱(2-60 [2-03-3-31]; p<0-0001)亚组中,使用 GLP-1 受体激动剂比使用 SGLT2 抑制剂有更高的透析或肾移植风险。解释根据虚弱状况制定明确、最新的 GLP-1 受体激动剂和 SGLT2 抑制剂使用指南,可改善 2 型糖尿病的管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Lancet Healthy Longevity
Lancet Healthy Longevity GERIATRICS & GERONTOLOGY-
CiteScore
16.30
自引率
2.30%
发文量
192
审稿时长
12 weeks
期刊介绍: The Lancet Healthy Longevity, a gold open-access journal, focuses on clinically-relevant longevity and healthy aging research. It covers early-stage clinical research on aging mechanisms, epidemiological studies, and societal research on changing populations. The journal includes clinical trials across disciplines, particularly in gerontology and age-specific clinical guidelines. In line with the Lancet family tradition, it advocates for the rights of all to healthy lives, emphasizing original research likely to impact clinical practice or thinking. Clinical and policy reviews also contribute to shaping the discourse in this rapidly growing discipline.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信