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- Publisher Website: 10.1016/j.diabet.2020.09.005
- Scopus: eid_2-s2.0-85093924446
- PMID: 33039672
- WOS: WOS:000685236400004
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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
Title | SGLT2i as fourth-line therapy and risk of mortality, end-stage renal diseases and cardiovascular diseases in patients with type 2 diabetes mellitus |
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Authors | |
Keywords | Anti-diabetic drug Cardiovascular disease Diabetes complication Insulin therapy SGLT2 inhibitor |
Issue Date | 2020 |
Publisher | Elsevier 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? |
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. |
Persistent Identifier | http://hdl.handle.net/10722/289373 |
ISSN | 2023 Impact Factor: 4.6 2023 SCImago Journal Rankings: 1.557 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Wong, CKH | - |
dc.contributor.author | Tang, EHM | - |
dc.contributor.author | Man, KKC | - |
dc.contributor.author | Chan, EWY | - |
dc.contributor.author | Wong, ICK | - |
dc.contributor.author | Lam, CLK | - |
dc.date.accessioned | 2020-10-22T08:11:43Z | - |
dc.date.available | 2020-10-22T08:11:43Z | - |
dc.date.issued | 2020 | - |
dc.identifier.citation | Diabetes & Metabolism, 2020, Epub 2020-10-08 | - |
dc.identifier.issn | 1262-3636 | - |
dc.identifier.uri | http://hdl.handle.net/10722/289373 | - |
dc.description.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. | - |
dc.language | eng | - |
dc.publisher | Elsevier Masson. The Journal's web site is located at http://www.elsevier-masson.fr/diabetes-metabolism-1262-3636.html | - |
dc.relation.ispartof | Diabetes & Metabolism | - |
dc.subject | Anti-diabetic drug | - |
dc.subject | Cardiovascular disease | - |
dc.subject | Diabetes complication | - |
dc.subject | Insulin therapy | - |
dc.subject | SGLT2 inhibitor | - |
dc.title | SGLT2i as fourth-line therapy and risk of mortality, end-stage renal diseases and cardiovascular diseases in patients with type 2 diabetes mellitus | - |
dc.type | Article | - |
dc.identifier.email | Wong, CKH: carlosho@hku.hk | - |
dc.identifier.email | Tang, EHM: erichm@hku.hk | - |
dc.identifier.email | Man, KKC: mkckth@hku.hk | - |
dc.identifier.email | Chan, EWY: ewchan@hku.hk | - |
dc.identifier.email | Wong, ICK: wongick@hku.hk | - |
dc.identifier.email | Lam, CLK: clklam@hku.hk | - |
dc.identifier.authority | Wong, CKH=rp01931 | - |
dc.identifier.authority | Chan, EWY=rp01587 | - |
dc.identifier.authority | Wong, ICK=rp01480 | - |
dc.identifier.authority | Lam, CLK=rp00350 | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1016/j.diabet.2020.09.005 | - |
dc.identifier.pmid | 33039672 | - |
dc.identifier.scopus | eid_2-s2.0-85093924446 | - |
dc.identifier.hkuros | 316234 | - |
dc.identifier.volume | Epub 2020-10-08 | - |
dc.identifier.isi | WOS:000685236400004 | - |
dc.publisher.place | France | - |
dc.identifier.issnl | 1262-3636 | - |