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Risk of amputations associated with SGLT2 inhibitors compared to DPP‐4 inhibitors: A propensity‐matched cohort study
Author(s) -
Adimadhyam Sruthi,
Lee Todd A.,
Calip Gregory S.,
Smith Marsh Daphne E.,
Layden Brian T.,
Schumock Glen T.
Publication year - 2018
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13459
Subject(s) - medicine , dapagliflozin , empagliflozin , hazard ratio , amputation , propensity score matching , discontinuation , proportional hazards model , dipeptidyl peptidase 4 , cohort , cumulative incidence , diabetes mellitus , confidence interval , lower risk , type 2 diabetes , surgery , endocrinology
Aim To determine the risk of amputations associated with sodium‐glucose co‐transporter‐2 inhibitors (SGLT2i) relative to dipeptidyl peptidase‐4 inhibitors (DPP4i). Materials and Methods We conducted an active comparator, new user cohort study using data from the Truven Health MarketScan (2009‐2015) databases. Patients aged ≥18 years newly initiating SGLT2i or DPP4i between April 1, 2013 and March 31, 2015 were included. Patients were matched 1:1 on high dimensional propensity scores and followed until the earliest of any amputation, treatment discontinuation, disenrollment or end of study period (December 31, 2015). Cox proportional hazards models were used to estimate hazard ratios (HR) and robust 95% confidence intervals (CI) for amputation risk. Results There were 30 216 comparable patients in each arm after matching. Over a median follow‐up of 0.6 years, there were 60 amputations (SGLT2i: 36; DPP4i: 24), most at the level of partial foot (75%) and associated with diabetes‐related vascular disease (66.7%). The incidence of amputations was higher among SGLT2i patients (1.62 vs. 1.15 per 1000 person‐years) with a HR of 1.38 (CI: 0.83‐2.31). In subgroup analyses, risk differed by type of SGLT2i: canagliflozin, HR 1.15 (CI: 0.63‐2.09); dapagliflozin or empagliflozin, HR 2.25 (CI: 0.78‐6.47). Conclusion All SGLT2i had an elevated, though not statistically significant, risk for amputations.