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There are limited data on cardiovascular efficacy and safety of type 2 diabetes therapies in Japan, where treatments are characterized by lower metformin use and higher dipeptidyl peptidase‐4 inhibitor (DPP4i) use versus other countries. We investigated the cardiovascular outcomes in Japanese patients with type 2 diabetes initiating sodium–glucose cotransporter 2 inhibitors (SGLT2i) matched 1:1 to patients initiating other glucose‐lowering drugs (33,890 patients/group) or DPP4i (9,876 patients/group). SGLT2i initiation was associated with lower risks (hazard ratio of in‐hospital death [death] 0.56, 95% confidence interval [CI] 0.47–0.67; hospitalization for heart failure 0.75, 95% CI 0.64–0.89; composite of hospitalization for heart failure or death 0.65, 95% CI 0.58–0.74 and stroke 0.66, 95% CI 0.52–0.84 versus other glucose‐lowering drugs and lower risks of death 0.52, 95% CI 0.36–0.73) and composite of hospitalization for heart failure or death (0.65, 95% CI 0.51–0.83) versus DPP4i. In conclusion, SGLT2i initiators had lower risks of cardiovascular events versus other glucose‐lowering drug initiators and, uniquely, versus DPP4i initiators in Japanese real‐world practice.

Sodium–glucose cotransporter 2 inhibitors compared with other glucose‐lowering drugs in Japan: Subanalyses of the CVD‐REAL 2 Study