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Adverse events decrease with DPP-IV, SGLT2 inhibitors in type 2 diabetes
The risks for all-cause mortality, cardiovascular disease and severe hypoglycemia are reduced for adults with type 2 diabetes prescribed DPP-IV inhibitors or the SGLT2 inhibitor dapagliflozin compared vs. insulin alone, study data from Sweden show.
Thomas Nyström, MD, of the unit for diabetes research, division of internal medicine, department of clinical science and education at the Karolinska Institute in Sweden, and colleagues evaluated data on adults with type 2 diabetes who filled a first-time prescription for a DPP-IV inhibitor or dapagliflozin (Farxiga, AstraZeneca), the only SGLT2 inhibitor available in Sweden during the study period (oral drug group, n = 10,879), or for insulin (insulin group, n = 10,879) between July 1, 2013, and Dec. 31, 2014, to determine the effect of the drugs on all-cause mortality, CVD and severe hypoglycemia. Median follow-up times were 1.51 years in the oral drug group and 1.53 years in the insulin group.
The oral drug group had a 44% decreased risk for all-cause mortality, 15% decreased risk for fatal and nonfatal CVD and a 74% decreased risk for severe hypoglycemia compared with the insulin group.
The risk for CVD was significantly lower in the dapagliflozin group (HR = 0.47; 95% CI, 0.24-0.93), whereas the DPP-IV inhibitors did not differ from insulin.
The dapagliflozin group had a 56% lower risk for all-cause mortality (HR = 0.44; 95% CI, 0.28-0.7) and a 49% decreased risk for fatal and nonfatal CVD (HR = 0.51; 95% CI, 0.3-0.86) compared with insulin. The DPP-IV inhibitor group had a 41% decreased risk for all-cause mortality compared with insulin (HR = 0.59; 95% CI, 0.51-0.67).
Compared with the insulin group, the DPP-IV inhibitor group had a 69% lower risk for severe hypoglycemia (HR = 0.31; 95% CI, 0.15-0.66), whereas the decreased risk for the dapagliflozin group did not reach statistical significance.
“Despite insulin’s clear advantages of blood glucose control and prevention of microvascular disease, there is increasing evidence that other complications may limit its benefits in the treatment of patients with type 2 diabetes,” the researchers wrote. “During the last few years, newer [glucose-lowering drugs] with less risk of hypoglycemia and CVD have become available and may be therapeutic alternatives with a lower risk of serious adverse effects.” – by Amber Cox
Disclosure: Nyström reports various financial ties with AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novo Nordisk and Sanofi Aventis. Please see the full study for a list of all other authors’ relevant financial disclosures.