Diabetes, obesity & metabolismFeb 4, 2022

Heart and blood vessel outcomes linked to diabetes drugs SGLT2 inhibitors versus DPP-4 inhibitors in people with diabetes and kidney disease

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Apr 6, 2026

Abstract

New users of SGLT-2 inhibitors had a 23% lower risk of non-fatal myocardial infarction or stroke compared to DPP-4 inhibitors in patients with type 2 diabetes and no chronic kidney disease.

SGLT-2 inhibitors were associated with lower risks of heart failure hospitalization in patients with type 2 diabetes and no chronic kidney disease.
In patients with type 2 diabetes and chronic kidney disease stages 1-2, SGLT-2 inhibitors also showed a reduced risk of heart failure hospitalization.
No significant association between SGLT-2 inhibitors and heart failure hospitalization was observed in patients with chronic kidney disease stage 3a.
SGLT-2 inhibitors may suggest a benefit in reducing risk of non-fatal myocardial infarction or stroke in patients with type 2 diabetes, though this was not statistically significant in chronic kidney disease stages 1-2 and 3a.

Simplified

AIM: To determine the association with cardiovascular (CV) outcomes of sodium-glucose co-transporter-2 (SGLT-2) inhibitors compared with dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD).

MATERIALS AND METHODS: We conducted a population-based cohort study of new users of SGLT-2 inhibitors and DPP-4 inhibitors with T2D and CKD using data from Optum Clinformatics DataMart. We assembled three cohorts: T2D/no CKD, T2D/CKD 1-2, and T2D/CKD 3a. The study outcomes were (a) time to first heart failure (HF) hospitalization and (b) time to a composite CV endpoint comprised of non-fatal myocardial infarction (MI) or stroke. After inverse probability of treatment weighting, we used proportional hazards regression to estimate hazard ratios (HR) and 95% confidence intervals (CI).

RESULTS: New users of SGLT-2 inhibitors versus DPP-4 inhibitors had lower risks of HF hospitalization in the T2D/no CKD (HR, 0.76; 95% CI, 0.70, 0.82) and T2D/CKD 1-2 (HR, 0.63; 95% CI, 0.48, 0.84) cohorts, but no significant association was present in the T2D/CKD 3a cohort. Compared with prescription of DPP-4 inhibitors, SGLT-2 inhibitors were associated with lower risks of non-fatal MI or stroke of 23% (HR, 0.77; 95% CI, 0.70, 0.85) in the T2D/no CKD cohort, but no significant associations were present in the T2D/CKD 1-2 and T2D/CKD 3a cohorts.

CONCLUSIONS: Incident prescription of SGLT-2 inhibitors was associated with lower risks of HF hospitalization but not with non-fatal MI or stroke despite suggesting benefit, relative to prescription of DPP-4 inhibitor across different stages of CKD.

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Heart and blood vessel outcomes linked to diabetes drugs SGLT2 inhibitors versus DPP-4 inhibitors in people with diabetes and kidney disease

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