SGLT-2抑制剂、GLP-1受体激动剂和DPP-4抑制剂在2型糖尿病中的心血管有效性和安全性比较。

IF 14.8 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Diabetes Care Pub Date : 2023-11-01 DOI:10.2337/dc23-0671
Alexander Kutz, Dae Hyun Kim, Deborah J Wexler, Jun Liu, Sebastian Schneeweiss, Robert J Glynn, Elisabetta Patorno
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引用次数: 0

摘要

目的:评估钠-葡萄糖协同转运蛋白2抑制剂(SGLT-2is)、胰高血糖素样肽1受体激动剂(GLP-1RA)和二肽基肽酶4抑制剂(DPP-4is)对不同虚弱阶层的老年2型糖尿病(T2D)患者的心血管有效性和安全性。研究设计和方法:我们使用启动SGLT-2is、GLP-1RA或DPP-4is的T2D医疗保险受益人(2013-2019)的数据,进行了三项1:1倾向评分匹配的队列研究,每项研究按三个虚弱阶层进行分层。在事件时间分析中,我们评估了急性心肌梗死、缺血性中风、心力衰竭住院治疗和全因死亡率的主要心血管有效性复合结果。主要安全性结果是与SGLT-2i或GLP-1RA使用有关的严重不良事件的复合。结果:与DPP-4is相比,SGLT-2is(n=120202配对)的主要有效性结果的总危险比(HR)为0.72(95%CI 0.69-0.75),相应的发病率差异(IRD)为-13.35(95%CI-15.06至-11.64)。非肥胖人群的IRD范围为-6.74(95%CI-8.61至-4.87),体弱人群的IRD范围为-27.24(95%CI-41.64至-12.84)(交互作用P<0.01)。与DPP-4is相比,GLP-1RA观察到一致的益处(n=113864),总HR为0.74(95%CI 0.71-0.77),IRD为-15.49(95%CI-17.46至-13.52)。最低脆弱层的IRD为-7.02(95%CI-9.23至-4.81),最高脆弱层为-25.88(95%CI-38.30至-13.46)(交互作用P<0.01)。SGLT-2is与GLP-1RA的结果(n=89865)具有可比性。SGLT-2is或GLP-1RA的严重不良事件并不比DPP-4is更频繁。结论:SGLT-2is和GLP-1RA安全地改善了心血管结局和全因死亡率,在体弱人群中具有最大的绝对益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparative Cardiovascular Effectiveness and Safety of SGLT-2 Inhibitors, GLP-1 Receptor Agonists, and DPP-4 Inhibitors According to Frailty in Type 2 Diabetes.

Objective: To evaluate the comparative cardiovascular effectiveness and safety of sodium-glucose cotransporter 2 inhibitors (SGLT-2is), glucagon-like peptide 1 receptor agonists (GLP-1RAs), and dipeptidyl peptidase 4 inhibitors (DPP-4is) in older adults with type 2 diabetes (T2D) across different frailty strata.

Research design and methods: We performed three 1:1 propensity score-matched cohort studies, each stratified by three frailty strata, using data from Medicare beneficiaries (2013-2019) with T2D who initiated SGLT-2is, GLP-1RAs, or DPP-4is. In time-to-event analyses, we assessed the primary cardiovascular effectiveness composite outcome of acute myocardial infarction, ischemic stroke, hospitalization for heart failure, and all-cause mortality. The primary safety outcome was a composite of severe adverse events that have been linked to SGLT-2i or GLP-1RA use.

Results: Compared with DPP-4is, the overall hazard ratio (HR) for the primary effectiveness outcome associated with SGLT-2is (n = 120,202 matched pairs) was 0.72 (95% CI 0.69-0.75), corresponding to an incidence rate difference (IRD) of -13.35 (95% CI -15.06 to -11.64). IRD ranged from -6.74 (95% CI -8.61 to -4.87) in nonfrail to -27.24 (95% CI -41.64 to -12.84) in frail people (P for interaction < 0.01). Consistent benefits were observed for GLP-1RAs compared with DPP-4is (n = 113,864), with an overall HR of 0.74 (95% CI 0.71-0.77) and an IRD of -15.49 (95% CI -17.46 to -13.52). IRD in the lowest frailty stratum was -7.02 (95% CI -9.23 to -4.81) and -25.88 (95% CI -38.30 to -13.46) in the highest (P for interaction < 0.01). Results for SGLT-2is versus GLP-1RAs (n = 89,865) were comparable. Severe adverse events were not more frequent with SGLT-2is or GLP-1RAs than DPP-4is.

Conclusions: SGLT-2is and GLP-1RAs safely improved cardiovascular outcomes and all-cause mortality, with the largest absolute benefits among frail people.

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来源期刊
Diabetes Care
Diabetes Care 医学-内分泌学与代谢
CiteScore
27.80
自引率
4.90%
发文量
449
审稿时长
1 months
期刊介绍: The journal's overarching mission can be captured by the simple word "Care," reflecting its commitment to enhancing patient well-being. Diabetes Care aims to support better patient care by addressing the comprehensive needs of healthcare professionals dedicated to managing diabetes. Diabetes Care serves as a valuable resource for healthcare practitioners, aiming to advance knowledge, foster research, and improve diabetes management. The journal publishes original research across various categories, including Clinical Care, Education, Nutrition, Psychosocial Research, Epidemiology, Health Services Research, Emerging Treatments and Technologies, Pathophysiology, Complications, and Cardiovascular and Metabolic Risk. Additionally, Diabetes Care features ADA statements, consensus reports, review articles, letters to the editor, and health/medical news, appealing to a diverse audience of physicians, researchers, psychologists, educators, and other healthcare professionals.
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