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Safety of sodium-glucose co-transporter-2 inhibitors on amputation across categories of baseline cardiovascular disease and diuretics use in patients with type 2 diabetes

Authors
 Sohee Park  ;  Han Eol Jeong  ;  Sungho Bea  ;  Oriana H Y Yu  ;  Young Min Cho  ;  Seng Chan You  ;  Kenneth K C Man  ;  Ju-Young Shin 
Citation
 DIABETES OBESITY & METABOLISM, Vol.25(11) : 3248-3258, 2023-11 
Journal Title
DIABETES OBESITY & METABOLISM
ISSN
 1462-8902 
Issue Date
2023-11
MeSH
Amputation, Surgical ; Cardiovascular Diseases* / complications ; Cohort Studies ; Diabetes Mellitus, Type 2* / complications ; Diabetes Mellitus, Type 2* / drug therapy ; Diabetes Mellitus, Type 2* / epidemiology ; Dipeptidyl-Peptidase IV Inhibitors* / adverse effects ; Diuretics ; Glucose ; Humans ; Hypoglycemic Agents ; Risk Factors ; Sodium ; Sodium-Glucose Transporter 2 Inhibitors* / adverse effects ; Symporters*
Keywords
SGLT2 inhibitors ; amputation ; cardiovascular disease ; diuretics ; type 2 diabetes
Abstract
Aim: To assess the risk of amputation associated with sodium-glucose co-transporter-2 inhibitors (SGLT2is) among patients with type 2 diabetes, across categories of baseline cardiovascular disease (CVD) and diuretic use (DU).Materials and Methods: We conducted an active comparator, new-user cohort study using Korea's nationwide claims data (2015-2020). The study cohort consisted of patients with type 2 diabetes who initiated SGLT2is or dipeptidyl peptidase-4 inhibitors (DPP4is). Cohort entry was defined by first prescription date. We then classified patients into four discrete subcohorts based on their baseline status of CVD and DU as (1) CVD+/DU+, (2) CVD+/DU-, (3) CVD-/DU+ and (4) CVD-/DU-. We performed 1:1 propensity score (PS) matching within each cohort and estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for the risk of amputation with SGLT2is versus DPP4is using Cox models.Results: We identified 219 900 PS-matched pairs of SGLT2is and DPP4is (CVD+/DU+, n = 11 719; CVD+/DU-, n = 26 092; CVD-/DU+, n = 26 894; and CVD-/DU-, n = 155 195), with well-balanced baseline covariates across all cohorts. Significantly lower risks of amputation with SGLT2is versus DPP4is were found in CVD+/DU+ (HR 0.36, 95% CI 0.14-0.90), CVD+/DU- (0.45, 0.21-0.99) and CVD-/DU- (0.48, 0.33-0.70), but not in CVD-/DU+ (0.54, 0.26-1.12). Consistent trends in estimates were found across various sensitivity analyses.Conclusions: Initiating SGLT2is against DPP4is did not increase the risk of amputation across patient populations of varying vulnerability. These findings based on routine practice will reassure clinicians of the safety of SGLT2is with regard to amputation risk in selected high-risk patients with type 2 diabetes.
Full Text
https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.15221
DOI
10.1111/dom.15221
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
Yonsei Authors
You, Seng Chan(유승찬) ORCID logo https://orcid.org/0000-0002-5052-6399
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/199336
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