GLP-1 use tied to lower risk for hyperkalemia than DPP-IV therapy in type 2 diabetes
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Key takeaways:
- Adults with type 2 diabetes who began GLP-1 therapy were less likely to develop hyperkalemia than adults starting a DPP-IV.
- Discontinuation of renin-angiotensin system inhibitors was more common with DPP-IV use.
Adults with type 2 diabetes using a GLP-1 receptor agonist are less likely to develop hyperkalemia than those using a DPP-IV inhibitor, according to a study published in JAMA Internal Medicine.
In an analysis of data from the Stockholm Creatinine Measurements project, researchers assessed potassium levels among adults with type 2 diabetes starting GLP-1 or DPP-IV therapy. In addition to hyperkalemia incidence being higher among DPP-IV users compared with those using a GLP-1, the GLP-1 group was less likely to discontinue renin-angiotensin system inhibitor use than adults using a DPP-IV.
“Treatment with GLP-1 receptor agonists may enable wider use of the guideline-recommended cardioprotective and renoprotective medications and contribute to improving clinical outcomes in this population,” Yang Xu, Pharm, PhD, of the department of pharmacy administration and clinical pharmacy at Peking University School of Pharmaceutical Sciences, Beijing, and colleagues wrote.
Researchers collected data from 33,280 adults with type 2 diabetes living in Stockholm who started GLP-1 or DPP-IV therapy from 2008 to 2021 and had no record of using either class of drug in the year before initiation (mean age, 63.7 years; 59.7% men). Participants were considered to have used renin-angiotensin system inhibitors if there was overlap between the start of GLP-1 or DPP-IV therapy and the pill supply of the last recorded renin-angiotensin system inhibitor prescription fill. Hyperkalemia was defined as a potassium level of more than 5 mEq/L. Moderate to severe hyperkalemia was a potassium level of more than 5.5 mEq/L. Follow-up continued until hyperkalemia, death, emigration or the end of the study in 2021.
Of the study group, 19,647 initiated DPP-IV therapy and 13,633 began using a GLP-1. During a median 3.9 months, hyperkalemia occurred in 752 people. Adults using a GLP-1 had a lower hyperkalemia risk than those using a DPP-IV (HR = 0.62; 95% CI, 0.5-0.76). The risk for moderate to severe hyperkalemia was also lower for GLP-1 users than adults using a DPP-IV (HR = 0.52; 95% CI, 0.28-0.84).
During a median 3.9 years of follow-up, there were 1,213 repeat hyperkalemia episodes. The GLP-1 group was less likely to have repeat hyperkalemia than adults using a DPP-IV (incidence rate ratio = 0.48; 95% CI, 0.42-0.56).
Renin-angiotensin system inhibitors were used by 21,751 participants at the time GLP-1 or DPP-IV therapy began. During a median follow-up of 3.9 months, 2,351 adults stopped renin-angiotensin system inhibitor therapy. GLP-1 users were less likely to discontinue renin-angiotensin system inhibitor therapy than adults using a DPP-IV (HR = 0.89; 95% CI, 0.82-0.97).
“Compared with DPP-IV inhibitor users, GLP-1 receptor agonist users had lower rates of renin-angiotensin system inhibitor discontinuation,” the researchers wrote. “Although the observational nature of our study does not allow us to determine whether the lower hyperkalemia rates causally explain this finding, many studies show that hyperkalemia often leads to dose reduction or discontinuation of renin-angiotensin system inhibitor use in clinical practice and that this clinical decision is associated with worse clinical outcomes.”
The researchers noted the study lacked information on race and ethnicity and the findings may not be generalizable in other regions of the world.
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