The association between sodium glucose cotransporter‐2 inhibitors vs dipeptidyl peptidase‐4 inhibitors and renal outcomes in people discharged from hospital with type 2 diabetes: A population‐based cohort study

Abstract

AbstractBackgroundWe investigated the association between post‐hospital discharge use of sodium glucose cotransporter‐2 inhibitors (SGLT‐2is) compared to dipeptidyl peptidase‐4 inhibitors (DPP‐4is) and the incidence of hospitalization for acute renal failure (ARF) and chronic kidney disease (CKD) in people with type 2 diabetes.MethodsWe conducted a retrospective cohort study using linked hospital and prescription data. Our cohort included people aged ≥30 years with type 2 diabetes discharged from a hospital in Victoria, Australia, from December 2013 to June 2018. We compared new users of SGLT‐2is with new users of DPP‐4is following discharge. People were followed from first dispensing of a SGLT‐2i or DPP‐4i to a subsequent hospital admission for ARF or CKD. We used competing risk models with inverse probability of treatment weighting (IPTW) to estimate subhazard ratios.ResultsIn total, 9620 people initiated SGLT‐2is and 9962 initiated DPP‐4is. The incidence rate of ARF was 12.3 per 1000 person‐years (median years of follow‐up [interquartile range [IQR] 1.4 [0.7–2.2]) among SGLT‐2i initiators and 18.9 per 1000 person‐years (median years of follow‐up [IQR] 1.7 [0.8–2.6]) among DPP‐4i initiators (adjusted subhazard ratio with IPTW 0.78; 95% confidence interval [CI] 0.70–0.86). The incidence rate of CKD was 6.0 per 1000 person‐years (median years of follow‐up [IQR] 1.4 [0.7–2.2]) among SGLT‐2i initiators and 8.9 per 1000 person‐years (median years of follow‐up [IQR] 1.7 [0.8–2.6]) among DPP‐4i initiators (adjusted subhazard ratio with IPTW 0.83; 95% CI 0.73–0.94).ConclusionsReal‐world data support using SGLT‐2is over DPP‐4is for preventing acute and chronic renal events in people with type 2 diabetes.image