T2D: SGLT2 Inhibitors Lower the Risk of All-cause Mortality, Hospitalisations for HF and CKD

Pavankumar Kamat


May 31, 2021


  • In patients with type 2 diabetes (T2D), sodium-glucose co-transporter-2 inhibitors (SGLT2i) significantly reduced the risk of all-cause mortality and hospitalisations for heart failure (HF) and chronic kidney disease (CKD) compared with dipeptidyl peptidase-4 inhibitors (DPP4i), irrespective of the presence or absence of cardiovascular and renal disease (CVRD).

Why this matters

  • Findings highlight the need to introduce SGLT2i early in the management of high-risk patients with T2D.

Study design

  • The retrospective cohort study matched 24,438 patients with T2D receiving an SGLT2i (1:1) with those receiving a DPP4i using propensity score matching, stratified based on the presence of CVRD.

  • Primary outcomes: all-cause mortality, cardiovascular (CV) death or hospitalisation for HF, myocardial infarction, stroke, and CKD.

  • Funding: AstraZeneca.

Key results

  • SGLT2i vs DPP4i was associated with a lower risk of (HR; 95% CI):

    • all-cause mortality (0.73; 0.63-0.84);

    • CV mortality (0.80; 0.66-0.97); and

    • hospitalisation for HF (0.74; 0.65-0.84) and CKD (0.51; 0.47-0.856 P<.001 for all).

  • In patients without CVRD, SGLT2i vs DPP4i was associated with a lower risk of (HR; 95% CI):

    • all-cause mortality (0.71; 0.57-0.88; P=.002); and

    • hospitalisation for HF (0.76; 0.59-0.98; P=.035) and CKD (0.75; 0.63-0.88; P<.001).

  • Similarly, in patients with CV disease or at high risk, SGLT2i vs DPP4i was associated with a lower risk of (HR; 95% CI):

    • all-cause mortality (0.69; 0.59-0.82; P<.001);

    • CV mortality (0.76; 0.62-0.95; P=.014); and

    • hospitalisation for HF (0.73; 0.63-0.85; P<.001), stroke (0.75; 0.59-0.94; P=.013), and CKD (0.49; 0.43-0.54; P<.001).

  • Results were consistent across subgroups and sensitivity analyses.


  • Retrospective.


Idris I, Zhang R, Mamza JB, Ford M, Morris T, Banerjee A, Khunti K, Tulip Mark Greener J. Lower Risk of Hospitalisation for Heart Failure, Kidney Disease and Death with Sodium Glucose Co-Transporter-2 Compared to Dipeptidyl Peptidase-4 Inhibitors in Type 2 Diabetes Regardless of Prior Cardiovascular or Kidney Disease: A Retrospective Cohort Study in UK Primary Care. Diabetes Obes Metab. 2021 May 11 [Epub ahead of print]. doi: 10.1111/dom.14437. PMID: 33973690.  View abstract 

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


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