Samita Garg , Thabet Qapaja , Osama Hamid , Gizem Kaya , Rashid Abdel-Razeq , Dina Alayan , Mohammed Abu-Rumaileh , Anthony Lembo , Steven Nissen
{"title":"2型糖尿病成人胰高血糖素样肽-1受体激动剂与钠-葡萄糖共转运蛋白-2抑制剂的全因死亡率和胃肠道不良反应","authors":"Samita Garg , Thabet Qapaja , Osama Hamid , Gizem Kaya , Rashid Abdel-Razeq , Dina Alayan , Mohammed Abu-Rumaileh , Anthony Lembo , Steven Nissen","doi":"10.1016/j.gastha.2025.100736","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and Aims</h3><div>Glucagon-like peptide-1 receptor agonists (GLP-1RA) are increasingly used in adults with type 2 diabetes (T2D), with or without obesity. The incidence of gastrointestinal (GI) adverse effects (AEs) of GLP-1RA in T2D is unclear. This study aimed to evaluate all-cause mortality and GI AEs in T2D patients treated with GLP-1RA compared to those treated with sodium–glucose cotransporter-2 inhibitors (SGLT-2i).</div></div><div><h3>Methods</h3><div>A retrospective cohort study used electronic health records from the TriNetX Multi-Institutional Database (January 1, 2021, to December 31, 2022). T2D patients on GLP-1RA were compared to those on SGLT-2i. Primary outcomes were incident GI AEs and all-cause mortality. 1:1 propensity score matching was performed to reduce confounding, and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated for each outcome.</div></div><div><h3>Results</h3><div>The study included 3.2 million adults with T2D, with 104,947 prescribed a GLP-1RA compared with a matched cohort prescribed a SGLT-2i. After matching, baseline characteristics were similar, with a mean age of 62 ± 12 years and mean glycated hemoglobin of 8.0 ± 2.0%. About 30% of participants were from under-represented minority groups. At 24-month follow-up, patients prescribed a GLP-1RA had higher odds of being diagnosed with gastroparesis (GP) and gastroesophageal reflux disease (GERD) compared those prescribed a SGLT-2i, with aORs of 1.24 (95% CI, 1.11–1.38) for GP and 1.14 (95% CI, 1.11–1.18) for GERD. The risk of acute pancreatitis was lower in the GLP-1RA group. All-cause mortality at 24 months had an odds ratio of 0.83 (95% CI: 0.80, 0.87) compared to SGLT-2i.</div></div><div><h3>Conclusion</h3><div>After 24 months of follow-up, patients treated with a GLP-1RA had higher odds of GP and GERD compared to those treated with a SGLT-2i. However, the odds of acute pancreatitis were lower in the GLP-1RA group. All-cause mortality was reduced by 17% in the GLP-1RA group.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 10","pages":"Article 100736"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"All-Cause Mortality and Gastrointestinal Adverse Effects in Adults With Type 2 Diabetes on Glucagon-Like Peptide-1 Receptor Agonists vs Sodium–Glucose Cotransporter-2 Inhibitors\",\"authors\":\"Samita Garg , Thabet Qapaja , Osama Hamid , Gizem Kaya , Rashid Abdel-Razeq , Dina Alayan , Mohammed Abu-Rumaileh , Anthony Lembo , Steven Nissen\",\"doi\":\"10.1016/j.gastha.2025.100736\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background and Aims</h3><div>Glucagon-like peptide-1 receptor agonists (GLP-1RA) are increasingly used in adults with type 2 diabetes (T2D), with or without obesity. The incidence of gastrointestinal (GI) adverse effects (AEs) of GLP-1RA in T2D is unclear. This study aimed to evaluate all-cause mortality and GI AEs in T2D patients treated with GLP-1RA compared to those treated with sodium–glucose cotransporter-2 inhibitors (SGLT-2i).</div></div><div><h3>Methods</h3><div>A retrospective cohort study used electronic health records from the TriNetX Multi-Institutional Database (January 1, 2021, to December 31, 2022). T2D patients on GLP-1RA were compared to those on SGLT-2i. Primary outcomes were incident GI AEs and all-cause mortality. 1:1 propensity score matching was performed to reduce confounding, and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated for each outcome.</div></div><div><h3>Results</h3><div>The study included 3.2 million adults with T2D, with 104,947 prescribed a GLP-1RA compared with a matched cohort prescribed a SGLT-2i. After matching, baseline characteristics were similar, with a mean age of 62 ± 12 years and mean glycated hemoglobin of 8.0 ± 2.0%. About 30% of participants were from under-represented minority groups. At 24-month follow-up, patients prescribed a GLP-1RA had higher odds of being diagnosed with gastroparesis (GP) and gastroesophageal reflux disease (GERD) compared those prescribed a SGLT-2i, with aORs of 1.24 (95% CI, 1.11–1.38) for GP and 1.14 (95% CI, 1.11–1.18) for GERD. The risk of acute pancreatitis was lower in the GLP-1RA group. All-cause mortality at 24 months had an odds ratio of 0.83 (95% CI: 0.80, 0.87) compared to SGLT-2i.</div></div><div><h3>Conclusion</h3><div>After 24 months of follow-up, patients treated with a GLP-1RA had higher odds of GP and GERD compared to those treated with a SGLT-2i. However, the odds of acute pancreatitis were lower in the GLP-1RA group. All-cause mortality was reduced by 17% in the GLP-1RA group.</div></div>\",\"PeriodicalId\":73130,\"journal\":{\"name\":\"Gastro hep advances\",\"volume\":\"4 10\",\"pages\":\"Article 100736\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Gastro hep advances\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2772572325001232\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Gastro hep advances","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772572325001232","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
All-Cause Mortality and Gastrointestinal Adverse Effects in Adults With Type 2 Diabetes on Glucagon-Like Peptide-1 Receptor Agonists vs Sodium–Glucose Cotransporter-2 Inhibitors
Background and Aims
Glucagon-like peptide-1 receptor agonists (GLP-1RA) are increasingly used in adults with type 2 diabetes (T2D), with or without obesity. The incidence of gastrointestinal (GI) adverse effects (AEs) of GLP-1RA in T2D is unclear. This study aimed to evaluate all-cause mortality and GI AEs in T2D patients treated with GLP-1RA compared to those treated with sodium–glucose cotransporter-2 inhibitors (SGLT-2i).
Methods
A retrospective cohort study used electronic health records from the TriNetX Multi-Institutional Database (January 1, 2021, to December 31, 2022). T2D patients on GLP-1RA were compared to those on SGLT-2i. Primary outcomes were incident GI AEs and all-cause mortality. 1:1 propensity score matching was performed to reduce confounding, and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated for each outcome.
Results
The study included 3.2 million adults with T2D, with 104,947 prescribed a GLP-1RA compared with a matched cohort prescribed a SGLT-2i. After matching, baseline characteristics were similar, with a mean age of 62 ± 12 years and mean glycated hemoglobin of 8.0 ± 2.0%. About 30% of participants were from under-represented minority groups. At 24-month follow-up, patients prescribed a GLP-1RA had higher odds of being diagnosed with gastroparesis (GP) and gastroesophageal reflux disease (GERD) compared those prescribed a SGLT-2i, with aORs of 1.24 (95% CI, 1.11–1.38) for GP and 1.14 (95% CI, 1.11–1.18) for GERD. The risk of acute pancreatitis was lower in the GLP-1RA group. All-cause mortality at 24 months had an odds ratio of 0.83 (95% CI: 0.80, 0.87) compared to SGLT-2i.
Conclusion
After 24 months of follow-up, patients treated with a GLP-1RA had higher odds of GP and GERD compared to those treated with a SGLT-2i. However, the odds of acute pancreatitis were lower in the GLP-1RA group. All-cause mortality was reduced by 17% in the GLP-1RA group.
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