Cardiovascular outcomes with thiazolidinediones and sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes mellitus undergoing peripheral artery revascularization

Abstract

Aims: The comparative effectiveness of anti-diabetic agents in patients with type 2 diabetes mellitus (T2DM) undergoing peripheral artery revascularization remains unclear. Methods: Using the Korean National Health Insurance Claims database (2015-2023), we identified patients with T2DM who underwent peripheral artery revascularization (endovascular or surgical). To control for baseline differences, we utilized 1:3 propensity score matching to compare thiazolidinediones (TZD) vs. dipeptidyl peptidase-4 inhibitors (DPP-4i), and sodium-glucose co-transporter-2 inhibitors (SGLT-2i) vs. DPP-4i. Stratified Cox regression model assessed the risk for the primary outcome, defined as a composite of major adverse limb events (repeated revascularization or amputation), stroke, myocardial infarction, admission for heart failure, and all-cause death. Results: The primary outcome occurred in 49.3% of TZD users versus 55.5% of DPP-4i users (HR 0.74; 95% CI 0.63-0.86; p <0.001) and in 39.7% of SGLT-2i users versus 52.2% of DPP-4i users (HR 0.88; 95% CI 0.79-0.98; p = 0.015). Regarding secondary outcomes, TZD users were associated with lower risks of major adverse limb events, and all-cause death compared with DPP-4i users. SGLT-2i treatment was associated with reduced allcause death. Conclusions: Among patients with T2DM undergoing peripheral artery revascularization, TZD and SGLT-2i were associated with favourable clinical outcomes compared to DPP-4i.