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Lower heart failure and chronic kidney disease risks associated with sodium‐glucose cotransporter‐2 inhibitor use in Japanese type 2 diabetes patients without established cardiovascular and renal diseases
Author(s) -
Komuro Issei,
Kadowaki Takashi,
Bodegård Johan,
Thuresson Marcus,
Okami Suguru,
Yajima Toshitaka
Publication year - 2021
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.14119
Subject(s) - medicine , hazard ratio , kidney disease , type 2 diabetes , heart failure , diabetes mellitus , renal function , dapagliflozin , propensity score matching , proportional hazards model , myocardial infarction , stroke (engine) , cardiology , confidence interval , endocrinology , mechanical engineering , engineering
Aims To examine heart failure (HF) and chronic kidney disease (CKD) risks reduction associated with sodium‐glucose cotransporter‐2 inhibitors (SGLT‐2i) compared to other glucose‐lowering drugs (oGLD) in the early stage of type 2 diabetes patients without established cardiovascular or renal diseases (CVRD‐free T2D). Materials and Methods We performed an observational cohort study using a Japanese hospital claims registry, Medical Data Vision. CVRD‐free T2D patients were identified between 1 April 2014 and 30 September 2018. SGLT‐2i and oGLD new users (and dipeptidyl peptidase 4 inhibitors [DPP‐4i] separately) were subjected to 1:1 propensity‐score matching analysis. Hazard ratios (HRs) of cardiorenal disease (HF and/or CKD), HF, CKD, stroke, myocardial infarction (MI), and all‐cause mortality, were estimated using unadjusted Cox regression. Results A total of 108 362 CVRD‐free patients including 54 181 SGLT‐2i and 54 181 oGLD users were matched. Baseline characteristics were well balanced (mean age 59.1 years, 63% male, and follow‐up 1.50 years [162 970 patient‐years]). Compared to oGLD group, SGLT‐2i group had lower risk of cardiorenal disease, HF, CKD, stroke, and all‐cause mortality with HRs (95% confidence intervals) 0.55 (0.49‐0.61), 0.73 (0.61‐0.87), 0.45 (0.39‐0.52), 0.69 (0.59‐0.81), and 0.52 (0.46‐0.58), respectively, while no difference in MI. These were consistent in 1:1 propensity‐score matching analysis between SGLT‐2i and DPP‐4i users (n = 17 232 in each group). Conclusions In Japanese CVRD‐free T2D patients, SGLT‐2i initiation was associated with lower risk of cardiorenal diseases, stroke, and all‐cause mortality compared to oGLD, suggesting preventive effect of SGLT‐2i treatment in the early stage of T2D patients without CVRD manifestation.