Hospitalisation Is a Strong Risk Factor for Discontinuation of Sodium-Glucose Cotransporter 2 Inhibitors for Type 2 Diabetes.

Abstract

Aims: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are commonly withheld during hospitalisation because of concerns about diabetic ketoacidosis. We examined whether hospitalisation was associated with discontinuation of SGLT2i and compared patterns with another anti-hyperglycaemic medicine without similar inpatient safety concerns: dipeptidyl peptidase-4 inhibitors (DPP-4i).

Materials and methods: We conducted a retrospective new-user cohort study using linked, population-level data for adult residents of New South Wales, Australia. Adults aged ≥ 40 years initiating SGLT2i or DPP-4i (separate cohorts) between 2016 and 2020 were followed until death, mid-2021, or treatment discontinuation (gap of ≥ 90 days without a dispensing of the index medicine). We used Cox proportional hazards models to estimate the association between hospitalisation and discontinuation, adjusting for demographic and clinical characteristics. We treated the 'hospitalisation period' (the inpatient stay plus the 90 days following discharge) as a time-dependent exposure.

Results: Among people initiating SGLT2i (n = 106 098), the median age was 63 years and 61% were male. Overall, 35.1% were hospitalised during follow-up, and discontinuation was substantially more frequent during the hospitalisation period (56.4 per 100 person-years) compared with other follow-up times (37.6 per 100 person-years). This association remained significant after adjustment (HR: 1.83; 95% CI: 1.79-1.87). Similar patterns were observed among DPP-4i treated people (HR: 1.55; 95% CI: 1.51-1.58).

Conclusions: Hospitalisation is a strong risk factor for discontinuation of SGLT2i and DPP-4i therapy. Strategies to support re-initiation of SGLT2i during transitions from hospital to community care are needed to prevent harm and maximise cardiorenal protective effects of these medicines.