Sodium-glucose cotransporter 2 inhibitor versus metformin as first-line therapy in patients with type 2 diabetes mellitus: a multi-institution database study

Cardiovascular Diabetology

Yu-Sheng Lin¹  Tien-Hsing Chen²  Chun-Tai Mao²  Shao-Wei Chen³  Chih-Hsiang Chang⁴  Chi-Chin Sun⁵  Dong-Yi Chen⁶  Victor Chien-Chia Wu⁶  Pao-Hsien Chu⁶  Yan-Rong Li⁷  Michael Wu⁸ 

[1] Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan;Department of Cardiology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan;Department of Cardiothoracic and Vascular Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan;Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan;Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan;Division of Cardiology, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, 33305, Taoyuan, Taiwan;Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan;Divison of Cardiovascular Medicine, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, USA;

关键词: Type 2 diabetes mellitus;    Sodium-glucose co-transporter 2 inhibitor;    Metformin;    Cardiovascular outcome;   

DOI  :  10.1186/s12933-020-01169-3

来源: Springer

【 摘 要 】

BackgroundSodium-glucose co-transporter 2 inhibitors (SGLT2i) has shown evidence of cardiovascular benefit in patients with type 2 diabetes mellitus (T2DM). Currently metformin is the guideline-recommended first-line treatment. We aimed to investigate the benefit of SGLT2i vs metformin as first-line therapy.MethodsElectronic medical records from Chang Gung Research Database during 2016–2019 were retrieved for patients with T2DM. Patients aged < 20, not receiving anti-diabetic medication, first-line treatment neither metformin nor SGLT2i were excluded. Primary outcomes were heart failure hospitalization, acute coronary syndrome, ischemic stroke, and all-cause mortality. Patients were followed up for events or December 31, 2019, whichever comes first.ResultsAfter exclusion criteria, a total of 41,020 patients with T2DM were eligible for analysis. There were 1100 patients with SGLT2i as first-line and 39,920 patients with metformin as first-line treatment. IPTW was used for propensity score matching. During one year follow-up, the hazard ratio (HR) of patients on SGLT2i as first-line treatment to patients on metformin as first-line treatment were HR 0.47 (95% CI 0.41–0.54, p < 0.0001) in heart failure hospitalization, HR 0.50 (95% CI 0.41–0.61, p < 0.0001) in acute coronary syndrome, HR 1.21 (95% CI 1.10–1.32, p < 0.0001) in ischemic stroke, and HR 0.49 (95% CI 0.44–0.55, p < 0.0001) in all-cause mortality.ConclusionsIn patients with T2DM, SGLT2i as first-line treatment may be associated with decreased events of heart failure hospitalization, acute coronary syndrome, and all-cause mortality, compared with metformin as first-line treatment. However, there may be an increased events of ischemic stroke using SGLT2i compared to metformin.

【 授权许可】

CC BY