Diabetes & metabolismApr 13, 2026

Heart health effects of GLP-1 receptor agonists versus DPP-4 inhibitors in dialysis patients with type 2 diabetes

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Jun 27, 2026

Abstract

Essence

In Japanese dialysis patients with type 2 diabetes, sustained GLP-1RA use was linked to a lower estimated 3-year MACE risk than DPP-4i use, but with uncertainty around the effect.

Evidence

This target trial emulation cohort study used Japanese administrative claims data from 4793 adults on maintenance dialysis, estimating 3-year MACE risk at 29.7% for 557 GLP-1RA initiators versus 37.6% for 4236 DPP-4i initiators after inverse-probability weighting.

Caveat

The 95% CI crossed no clear effect for the risk difference and ratio, and the observational design requires confirmation in randomized controlled trials before clinical adoption.

Simplified

AIM: Patients with type 2 diabetes (T2D) receiving dialysis have a very high risk of cardiovascular events. Evidence for the cardiovascular effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in this population remains limited. Here, we assessed this issue using a target trial emulation framework.

METHODS: We conducted a cohort study using a Japanese administrative claims database. We included adults aged 20 years or older with T2D receiving maintenance dialysis who initiated a GLP-1RA or a DPP-4i between April 2015 and March 2023. The primary outcome was the 3-year risk of major adverse cardiovascular events (MACE), defined as a composite of acute myocardial infarction, stroke, and cardiovascular death. The observational analogue of the per-protocol effect was estimated using pooled logistic regression with inverse probability weighting to adjust for baseline and time-varying confounders.

RESULTS: Among 4793 patients (557 GLP-1RA initiators and 4236 DPP-4i initiators), the estimated 3-year risk of MACE was 29.7% (95% CI, 22.3% to 38.3%) for GLP-1RA users and 37.6% (95% CI, 35.2% to 40.8%) for DPP-4i users, giving a risk difference of -8.0% (95% CI, -15.5% to 0.9%) and risk ratio of 0.79 (95% CI, 0.59 to 1.03).

CONCLUSION: Compared with DPP-4is, sustained use of GLP-1RAs may reduce the risk of MACE among patients with T2D receiving maintenance dialysis. These findings suggest a potential cardiovascular benefit but require confirmation in randomized controlled trials before introduction into clinical practice.

Full Text

Full text is available at the source.

View Full Text ↗

Featured in

GLP-1 TherapiesIssue #33

Semaglutide linked to 53% lower risk of death in dialysis patients with diabetes

↗

Heart health effects of GLP-1 receptor agonists versus DPP-4 inhibitors in dialysis patients with type 2 diabetes

Abstract

Full Text

Featured in

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Recent issues from the glp-1 therapies brief