Cardiovascular Outcomes in Patients Initiating First-Line Treatment of Type 2 Diabetes With Sodium–Glucose Cotransporter-2 Inhibitors Versus Metformin: A Cohort Study
Ann Intern Med 2022; doi:10.7326/M21-4012
This cohort study found that those initiating a SGLT2i as their first-line treatment for T2D showed a similar risk for a composite outcome of MI, stroke, and mortality – and lower risk for a composite of hospitalisation for heart failure (HHF) and mortality. Compared with those receiving metformin as their first-line treatment, the SGLT2i safety profile was similar, except for an increased risk of genital infections.
SGLT2i have demonstrated benefits relative to placebo from cardiovascular outcomes trials, including a risk reduction in HHF in study populations with CVD, or at high CV risk. But previous studies have focused on the effects of SGLT2i as second-line treatment. This population-based claims-data study aimed to assess outcomes among adults who initiated first-line SGLT2i versus metformin.
Over a mean 12 months of follow-up, SGLT2i and metformin initiators had a similar risk for the composite endpoints of MI/stroke/mortality, and MI/stroke/HHF/mortality. However, SGLT2i showed a lower risk for the individual HHF component, and a numerically lower risk for MI compared with metformin. Safety analyses showed a higher risk for genital infections with SGLT21i, but otherwise similar safety as those receiving metformin.