Wong,, CKH;
Tang, EHM;
Man, KKC;
Chan, EWY;
Wong, I;
Lam, CLK;
(2021)
SGLT2i as fourth-line therapy and risk of mortality, end-stage renal diseases and cardiovascular diseases in patients with type 2 diabetes mellitus.
Diabetes & Metabolism
, 47
(4)
, Article 101196. 10.1016/j.diabet.2020.09.005.
Preview |
Text
Wong_SGLT2i as fourth-line therapy and risk of mortality, end-stage renal diseases, cardiovascular diseases and severe hypoglycaemia in patients with type 2 diabetes mellitus_AAM2.pdf - Accepted Version Download (1MB) | Preview |
Abstract
Aim: Current guideline recommends insulin as fourth-line glucose-lowering medications. However, treatment effects of sodium glucose co-transporter-2 inhibitors (SGLT2i) on the risk of complications are uncertain. This study examines risks of all-cause mortality, cardiovascular diseases (CVD) and end-stage renal diseases (ESRD) in type 2 diabetes mellitus (T2DM) patients on triple oral glucose-lowering medications initiating SGLT2i, insulin or other oral medications. / Methods: A population-based retrospective cohort of patients with T2DM between 2006–2017 was extracted from Hong Kong Hospital Authority database. Patients who were initiated a fourth-line therapy with SGLT2i, insulin or other oral medications were included. Hazard ratios (HRs) for all-cause mortality, CVD and ESRD were assessed using Cox proportional hazard models. / Results: Over a median follow-up period of 18.5 months with 63,122 person-years, SGLT2i and insulin group had the lowest and highest incidence rate of all-cause mortality, CVD and ESRD (1.06, 0.65 and 0.61 vs 4.25, 5.58 and 4.39/100 person-years), respectively. Initiating SGLT2i as fourth-line medication had more benefits on CVD, in particular coronary heart disease and stroke. Insulin users had higher risks of CVD (HR = 8.04, 95%CI = 3.06–21.12) than SGLT2i users. SGLT2i was associated with insignificant reduction in ESRD (HR = 4.62, 95%CI = 0.73–29.09) and all-cause mortality (HR = 3.06, 95%CI = 0.75–12.45), and HF (HR = 2.99, 95%CI = 0.37–24.42) among patients without established HF. / Conclusion: Among T2DM patients initiating fourth-line therapy, SGLT2i users had significant benefits in lowering risk of CVD, and potential benefits in lowering risks of ESRD and all-cause mortality. SGLT2i was the preferred fourth-line glucose-lowering medication least likely to be associated with complication risks.
| Type: | Article |
|---|---|
| Title: | SGLT2i as fourth-line therapy and risk of mortality, end-stage renal diseases and cardiovascular diseases in patients with type 2 diabetes mellitus |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.diabet.2020.09.005 |
| Publisher version: | https://doi.org/10.1016/j.diabet.2020.09.005 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions. |
| Keywords: | Anti-diabetic drug, Cardiovascular disease, Diabetes complication, Insulin therapy, SGLT2 inhibitor, Type 2 diabetes |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10110778 |
Archive Staff Only
 |
View Item |
