Two years with GIOIA ‘Effects of gliflozins and gliptins on markers of cardiovascular damage in type 2 diabetes’: A prospective, multicentre, quasi‐experimental study on sodium‐glucose cotransporter 2 and dipeptidyl peptidase‐4 inhibitors in diabetes clinical practice

Jan 18, 2024Diabetes, obesity & metabolism

Effects of two diabetes drug types on heart damage markers in type 2 diabetes over two years

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Abstract

A total of 1150 patients with type 2 diabetes were enrolled, with 580 starting sodium-glucose cotransporter 2 inhibitors (SGLT-2i) and 570 starting dipeptidyl peptidase-4 inhibitors (DPP-4i).

Patients on SGLT-2i were approximately 6 years younger and 11 kg heavier than those on DPP-4i.
SGLT-2i users had higher initial HbA1c levels (1% more) and more albuminuria and cardiovascular events (16% more) compared to DPP-4i users.
Both treatment groups experienced a similar reduction in HbA1c levels (-0.8%).
22% of patients on SGLT-2i exhibited regression of carotid intima-media thickness (CIMT), while 10% showed regression of albuminuria, significantly better than DPP-4i outcomes.
In contrast, 23% of DPP-4i patients showed progression of CIMT, and 28% experienced worsening albuminuria.
Left ventricular ejection fraction improved by 3% in the SGLT-2i group only.

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AIM: To assess and compare the metabolic and vascular effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT-2i) and dipeptidyl peptidase-4 inhibitors (DPP-4i) in the clinical practice of patients with type 2 diabetes in Italy.

MATERIALS AND METHODS: GIOIA is a 2-year prospective, multicentre, quasi-experimental study that enrolled patients with type 2 diabetes initiating SGLT-2i or DPP-4i for inadequate glycaemic control [glycated haemoglobin (HbA1c) >7%] between March 2018 and March 2021. The primary endpoints were changes in markers of organ damage [carotid intima-media thickness (CIMT), albuminuria, myocardial function] and HbA1c from baseline to year 2.

RESULTS: In total, 1150 patients were enrolled in the study (SGLT-2i n = 580, DPP-4i n = 570). Patients initiated on SGLT-2i were younger (about 6 years) and heavier (about 11 kg), had higher HbA1c level (1% more), more albuminuria and cardiovascular events (16% more) than patients initiated on DPP-4i. CIMT and echocardiographic parameters were not significantly different. Propensity score matching yielded two groups, each consisting of 155 patients with diabetes with similar baseline characteristics. Despite a significant similar reduction in HbA1c levels in both groups (-0.8%), more patients on SGLT-2i had regression of CIMT and albuminuria (22% and 10%, respectively, p < .001 vs. DPP-4i); more patients on DPP-4i had progression of CIMT and albuminuria (23% and 28%, respectively, p < .001 vs. SGLT-2i). Left ventricular ejection fraction improved slightly (3%, p = .043) on SGLT-2i only.

CONCLUSIONS: In a real-world setting, both SGLT-2i and DPP-4i improve glycaemic control persisting after 2 years of treatment, with a robust effect on both CIMT and albuminuria regression for SGLT-2i as compared with DPP-4i in the propensity score matching.

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Two years with GIOIA ‘Effects of gliflozins and gliptins on markers of cardiovascular damage in type 2 diabetes’: A prospective, multicentre, quasi‐experimental study on sodium‐glucose cotransporter 2 and dipeptidyl peptidase‐4 inhibitors in diabetes clinical practice

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