SGLT2 Inhibitors vs GLP-1 Receptor Agonists and Clinical Outcomes in Patients With Diabetes With/Without Atrial Fibrillation

Mar 11, 2024The Journal of clinical endocrinology and metabolism

Health outcomes of SGLT2 inhibitors compared to GLP-1 receptor agonists in people with diabetes with or without irregular heartbeat

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Abstract

SGLT2 inhibitors are associated with a lower risk of hospitalization for heart failure in patients with atrial fibrillation, at a rate of 2.32 events per 100 person-years compared to 4.74 for GLP-1 receptor agonists.

Patients with atrial fibrillation had a higher incidence rate of adverse cardiovascular events compared to those without.
In the cohort with atrial fibrillation, SGLT2 inhibitors were linked to a reduced risk of hospitalization for heart failure compared to GLP-1 receptor agonists.
SGLT2 inhibitors also showed a lower risk of composite kidney outcomes in both atrial fibrillation and non-atrial fibrillation cohorts.
No significant differences were observed in the risk of major adverse cardiovascular events or all-cause mortality between SGLT2 inhibitors and GLP-1 receptor agonists for either cohort.

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CONTEXT: The coexistence of diabetes mellitus and atrial fibrillation (AF) is associated with substantial risks of adverse cardiovascular events.

OBJECTIVE: The relevant outcomes associated with the use of a sodium-glucose cotransporter-2 inhibitor (SGLT2i) vs glucagon-like peptide-1 receptor agonists (GLP-1RAs) among patients with type 2 diabetes (T2D) with/without concomitant AF remain unknown.

METHODS: In this nationwide retrospective cohort study from the Taiwan National Health Insurance Research Database, there were 344 392 and 31 351 patients with T2D without AF, and 11 462 and 816 T2D patients with AF treated with SGLT2is and GLP-1RAs, respectively, from May 1, 2016, to December 31, 2019. Patients were followed from the drug index date until the occurrence of study events, discontinuation of the index drug, or the end of the study period (December 31, 2020), whichever occurred first. We used propensity score-stabilized weight to balance covariates across the 2 medication groups.

RESULTS: The incidence rate of all study outcomes in patients with concomitant AF was much higher than in those without concomitant AF. For the AF cohort, SGLT2i vs GLP-1RA was associated with a lower risk of hospitalization for heart failure (HF) (2.32 vs 4.74 events per 100 person-years; hazard ratio [HR] 0.48, 95% CI 0.36-0.66), with no benefit seen for the non-AF cohort (P for homogeneity < .01). SGLT2i vs GLP-1RA was associated with a lower risk of composite kidney outcomes both in the AF (0.38 vs 0.79 events per 100 person-years; HR 0.47; 95% CI 0.23-0.96) and the non-AF cohorts (0.09 vs 0.18 events per 100 person-years; HR 0.53; 95% CI 0.43-0.64). There were no significant differences in the risk of major adverse cardiovascular events and all-cause mortality in those who received SGLT2i compared with GLP-1RA for the AF or non-AF cohorts.

CONCLUSION: Considering the high risk of developing HF and/or high prevalence of concomitant HF in patients with concomitant diabetes and AF, whether SGLT2is should be the preferred treatment to GLP-1RAs for such a high-risk population requires further investigation.

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SGLT2 Inhibitors vs GLP-1 Receptor Agonists and Clinical Outcomes in Patients With Diabetes With/Without Atrial Fibrillation

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