Superior Cardiovascular Benefits of SGLT2 Inhibitors Over DPP4 Inhibitors for Severe Diabetic Kidney Disease: A Population-Based Cohort Study

OBJECTIVES: There is no real-world evidence on the cardiovascular (CV) benefits of novel antidiabetic drugs (NOACs) for patients with diabetic kidney disease (DKD). This population-based study aims to compare the CV outcomes of dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose cotransporter-2 (SGLT-2) inhibitors in the Taiwanese DKD population.

METHODS: This cohort study identified prevalent new users of SGLT-2i and DPP-4i among the DKD population with an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m² from 2017 to 2018. The primary composite CV outcomes were acute myocardial infarction, stroke, hospitalization for heart failure, and cardiovascular death. Cox proportional-hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for these outcomes, adjusting for potential confounders identified through propensity score matching.

RESULTS: SGLT-2i users showed superior composite CV outcomes compared to DPP-4i users (HR: 0.74; CI: 0.64-0.85), with reduced risks of stroke (HR: 0.76; CI: 0.62-0.92) and hospitalization for heart failure (HR: 0.68; CI: 0.55-0.84). These findings remained consistent across analyses stratified by concomitant antidiabetic agents or intervals between DKD diagnosis and study drug initiation.