Effectiveness and safety of SGLT2 inhibitors compared to dipeptidyl peptidase (DPP)-4 inhibitors in older adults with type 2 diabetes: A nationwide population-based study.

AIMS This study examined the real-world cardiovascular effectiveness and safety associated with sodium-glucose cotransporter 2 (SGLT2) inhibitors treatment compared with dipeptidyl peptidase (DPP)-4 inhibitors in older adults with type 2 diabetes. MATERIALS AND METHODS In this retrospective cohort study, older adults with type 2 diabetes (aged ≥ 65 years) were identified in the Korean National Health Insurance Service database between September 2014 and December 2016. In total, 408,506 new users of SGLT2 inhibitor or DPP-4 inhibitor were propensity score matched. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for outcomes of interest: hospitalization for heart failure (HHF), all-cause death, myocardial infarction, stroke, diabetic ketoacidosis (DKA), bone fracture, severe hypoglycemia, genital infection, and urinary tract infection (UTI). RESULTS Compared to DPP-4 inhibitors, new users of SGLT2 inhibitors had a lower risk of HHF (HR, 0.86; 95% CI, 0.76-0.97), all-cause death (HR, 0.85; 95% CI, 0.75-0.98), and stroke (HR, 0.86; 95% CI, 0.77-0.97), but a similar risk for myocardial infarction (HR, 0.95; 95% CI, 0.77-1.19). The risks of DKA, bone fracture, and severe hypoglycemia were similar between groups, though genital infection (HR 2.44; 95% CI 2.22-2.67) and UTI (HR 1.05; 95% CI 1.00-21.11) were more frequent among new users of SGLT2 inhibitors compared to DPP-4 inhibitors. CONCLUSION Our findings suggest that initiation of SGLT2 inhibitors offers cardiovascular disease protection and can be used safely in older adults with type 2 diabetes. This article is protected by copyright. All rights reserved.