SGLT2is Lower Cardiorenal Risk in T2D Patients Without Cardiovascular and Renal Disease

Sarfaroj Khan 


October 20, 2020


  • Sodium-glucose cotransporter-2 inhibitors (SGLT2is) use was associated with a lower risk of heart failure (HF) and chronic kidney disease (CKD) vs dipeptidyl peptidase-4 inhibitors (DPP4is) in type 2 diabetes (T2D) patients free from cardiovascular (CV) and renal disease (CVRD), managed in routine clinical practice.

Why this matters

  • Cardiorenal disease risk-lowering effects of SGLT2is reported in clinical trials translate to a multinational real-world setting.

  • Findings support increased clinical focus on identifying and implementing early cardiorenal prevention strategies in the treatment of patients with T2D at the risk for cardiorenal events.

Study design

  • In this multinational observational study, CVRD-free new users of SGLT2is or DPP4is were propensity score-matched in a ratio of 1:1 (n=105,130 in each group) with a total follow-up of 187,955 patient-years.

  • Main outcomes: CVRD (diagnosis of HF and CKD), HF, CKD, stroke, myocardial infarction (MI), all-cause and CV mortality.

  • Funding: AstraZeneca.

Key results

  • Dapagliflozin (91.7%) and sitagliptin/linagliptin (55.0%) were the most commonly used agents in the SGLT2is and DPP4is group, respectively.

  • SGLT2is vs DPP4is were associated with a lower risk of:

    • CVRD (HR, 0.56; 95% CI, 0.42-0.74);

    • HF (HR, 0.71; 95% CI, 0.59-0.86);

    • CKD (HR, 0.44; 95% CI, 0.28-0.69); and

    • all-cause (HR, 0.67; 95% CI, 0.59-0.77) and CV (HR, 0.61; 95% CI, 0.44-0.85) mortality.

  • No differences were observed in the risk of stroke (HR, 0.87; 95% CI, 0.69-1.09) and MI (HR, 0.94; 95% CI, 0.80-1.11) between both groups.


  • Findings cannot be extended to all patients with T2D.


Birkeland KI, Bodegard J, Banerjee A, Kim DJ, Norhammar A, Eriksson JW, Thuresson M, Okami S, Ha KH, Kossack N, Mamza JB, Zhang R, Yajima T, Komuro I, Kadowaki T. Lower cardiorenal risk with sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes without cardiovascular and renal diseases: A large multinational observational study. Diabetes Obes Metab. 2020 Sep 07 [Epub ahead of print]. doi: 10.1111/dom.14189. PMID: 32893440 View abstract

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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