Comparative safety and cardiovascular effectiveness of sodium‐glucose cotransporter‐2 inhibitors and glucagon‐like peptide‐1 receptor agonists in nursing homes

May 23, 2024Diabetes, obesity & metabolism

Safety and heart health effects of two diabetes drugs in nursing home residents

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Abstract

Among 7,710 nursing home residents, SGLT2 inhibitors were associated with higher rates of diabetic ketoacidosis and death compared to GLP-1 receptor agonists.

SGLT2 inhibitors may lead to nearly double the risk of diabetic ketoacidosis compared to GLP-1 receptor agonists.
There is a 18% higher risk of death associated with SGLT2 inhibitors compared to GLP-1 receptor agonists.
Rates of urinary tract or genital infections and acute kidney injury were also higher among SGLT2 inhibitor users.
While rates of fall-related injuries and hypoglycemia were lower in SGLT2 inhibitor users, the estimates for these outcomes were imprecise.
SGLT2 inhibitors do not demonstrate superior effectiveness for cardiovascular outcomes compared to GLP-1 receptor agonists.

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AIM: Studies examining the safety and effectiveness of sodium-glucose cotransporter-2 inhibitors (SGLT2is) versus glucagon-like peptide-1 receptor agonists (GLP-1RAs) among community-dwelling adults may not generalize to nursing home (NH) residents, who are typically older and more multimorbid. We compared the safety and cardiovascular effectiveness of SGLT2is and GLP-1RAs among US NH residents.

MATERIALS AND METHODS: Eligible individuals were aged ≥66 years with type 2 diabetes mellitus and initiated an SGLT2i or GLP-1RA in an NH between 2013 and 2018. Safety outcomes included fall-related injuries, hypoglycaemia, diabetic ketoacidosis (DKA), urinary tract infection or genital infection, and acute kidney injury in the year following treatment initiation. Cardiovascular effectiveness outcomes included death, major adverse cardiovascular events and hospitalization for heart failure. Per-protocol adjusted hazard ratios (HR) were calculated using stabilized inverse probability of treatment and censoring weighted cause-specific hazard regression models accounting for 127 covariates.

RESULTS: The study population included 7710 residents (31.08% SGLT2i, 68.92% GLP-1RA). Compared with GLP-1RA initiators, SGLT2i initiators had higher rates of DKA (HR 1.95, 95% confidence limits 1.27, 2.99) and death (HR 1.18, 95% confidence limits 1.02, 1.36). Rates of urinary tract infection or genital infection, acute kidney injury, major adverse cardiovascular events, and heart failure were also elevated, while rates of fall-related injuries and hypoglycaemia were reduced, but all estimates were imprecise and highly compatible with no difference.

CONCLUSIONS: SGLT2is do not have superior, and may have inferior, effectiveness compared with GLP-1RAs for cardiovascular and mortality outcomes in NH residents. Residents initiating SGLT2is should be monitored closely for DKA.

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Comparative safety and cardiovascular effectiveness of sodium‐glucose cotransporter‐2 inhibitors and glucagon‐like peptide‐1 receptor agonists in nursing homes

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