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Article: SGLT2i as fourth-line therapy and risk of mortality, end-stage renal diseases and cardiovascular diseases in patients with type 2 diabetes mellitus

TitleSGLT2i as fourth-line therapy and risk of mortality, end-stage renal diseases and cardiovascular diseases in patients with type 2 diabetes mellitus
Authors
KeywordsAnti-diabetic drug
Cardiovascular disease
Diabetes complication
Insulin therapy
SGLT2 inhibitor
Issue Date2020
PublisherElsevier Masson. The Journal's web site is located at http://www.elsevier-masson.fr/diabetes-metabolism-1262-3636.html
Citation
Diabetes & Metabolism, 2020, Epub 2020-10-08 How to Cite?
AbstractAim: 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.
Persistent Identifierhttp://hdl.handle.net/10722/289373
ISSN
2020 Impact Factor: 6.041
2020 SCImago Journal Rankings: 1.480
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorWong, CKH-
dc.contributor.authorTang, EHM-
dc.contributor.authorMan, KKC-
dc.contributor.authorChan, EWY-
dc.contributor.authorWong, ICK-
dc.contributor.authorLam, CLK-
dc.date.accessioned2020-10-22T08:11:43Z-
dc.date.available2020-10-22T08:11:43Z-
dc.date.issued2020-
dc.identifier.citationDiabetes & Metabolism, 2020, Epub 2020-10-08-
dc.identifier.issn1262-3636-
dc.identifier.urihttp://hdl.handle.net/10722/289373-
dc.description.abstractAim: 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.-
dc.languageeng-
dc.publisherElsevier Masson. The Journal's web site is located at http://www.elsevier-masson.fr/diabetes-metabolism-1262-3636.html-
dc.relation.ispartofDiabetes & Metabolism-
dc.subjectAnti-diabetic drug-
dc.subjectCardiovascular disease-
dc.subjectDiabetes complication-
dc.subjectInsulin therapy-
dc.subjectSGLT2 inhibitor-
dc.titleSGLT2i as fourth-line therapy and risk of mortality, end-stage renal diseases and cardiovascular diseases in patients with type 2 diabetes mellitus-
dc.typeArticle-
dc.identifier.emailWong, CKH: carlosho@hku.hk-
dc.identifier.emailTang, EHM: erichm@hku.hk-
dc.identifier.emailMan, KKC: mkckth@hku.hk-
dc.identifier.emailChan, EWY: ewchan@hku.hk-
dc.identifier.emailWong, ICK: wongick@hku.hk-
dc.identifier.emailLam, CLK: clklam@hku.hk-
dc.identifier.authorityWong, CKH=rp01931-
dc.identifier.authorityChan, EWY=rp01587-
dc.identifier.authorityWong, ICK=rp01480-
dc.identifier.authorityLam, CLK=rp00350-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.diabet.2020.09.005-
dc.identifier.pmid33039672-
dc.identifier.scopuseid_2-s2.0-85093924446-
dc.identifier.hkuros316234-
dc.identifier.volumeEpub 2020-10-08-
dc.identifier.isiWOS:000685236400004-
dc.publisher.placeFrance-
dc.identifier.issnl1262-3636-

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