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Sodium‐glucose co‐transporter‐2 inhibitors and the risk of urosepsis: A multi‐site, prevalent new‐user cohort study
Author(s) -
Fisher Anat,
Fralick Michael,
Filion Kristian B.,
Dell'Aniello Sophie,
Douros Antonios,
Tremblay Éric,
Shah Baiju R.,
Ronksley Paul E.,
AlessiSeverini Silvia,
Hu Nianping,
Bugden Shawn C.,
Ernst Pierre,
Lix Lisa M.
Publication year - 2020
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.14082
Subject(s) - empagliflozin , dapagliflozin , hazard ratio , medicine , proportional hazards model , confidence interval , cohort , type 2 diabetes , canagliflozin , diabetes mellitus , endocrinology
Aim To compare urosepsis rates in patients with type 2 diabetes treated using sodium‐glucose co‐transporter‐2 inhibitors (SGLT2i) with dipeptidyl peptidase‐4 inhibitors (DPP4i) in a real‐world setting. Methods We conducted a matched cohort study using a prevalent new‐user design with time‐conditional propensity scores. New users of SGLT2i from seven Canadian provinces and the UK were matched to DPP4i users. The primary outcome was hospitalization with a diagnosis of urosepsis and the secondary outcome was Fournier's gangrene. Site‐specific hazard ratios for urosepsis comparing SGLT2i with DPP4i were estimated using Cox proportional hazards models and pooled using a random effects meta‐analysis. Results We included 208 244 users of SGLT2i and 208 244 users of DPP4i. Among SGLT2i users, 42% initiated canagliflozin, 31% dapagliflozin and 27% empagliflozin. During a mean follow‐up of 0.9 years, patients initiating SGLT2i had a lower rate of urosepsis compared with those receiving DPP4i. The pooled adjusted hazard ratio was 0.58 (95% confidence interval [CI]: 0.42‐0.80). The incidence rates of Fournier's gangrene were numerically similar in SGLT2i (0.08 per 1000 person‐years; 95% CI: 0.05‐0.13) and DPP4i users (0.14; 95% CI: 0.09‐0.21). Conclusions In this large, multi‐site study, we did not observe an increased risk for urosepsis associated with SGLT2i compared with DPP4i among patients with type 2 diabetes in a real‐world setting.