COMPARATIVE CARDIOVASCULAR AND KIDNEY EFFECTIVENESS OF GLP-1 RECEPTOR AGONISTS VERSUS OTHER GLUCOSE-LOWERING AGENTS IN PATIENTS WITH TYPE 2 DIABETES: A REAL-WORLD STUDY IN CHINA
Author(s)
Yuqing Fan, BS1, Linfeng Jiang, BS1, Nan Peng, PhD2, Ruolan Wei, BS1, guoxian Lu, BS1, Dongning Yao, PhD1;
1Nanjing Medical University, Nanjing, Jiangsu, China, 2School of Pharmaceutical Science and Technology,Tianjin University, Tianjin, China
1Nanjing Medical University, Nanjing, Jiangsu, China, 2School of Pharmaceutical Science and Technology,Tianjin University, Tianjin, China
OBJECTIVES: To compare the cardiovascular and kidney effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) versus other glucose-lowering agents in real-world patients with type 2 diabetes mellitus (T2DM) in China.
METHODS: This retrospective cohort study utilized electronic medical records from a large healthcare platform in Eastern China. Adult patients with T2DM who initiated a second-line antidiabetic medication after prior metformin monotherapy or no antidiabetic treatment between January 2018 and October 2024 were included. The primary cardiovascular outcome was major adverse cardiovascular events (MACE), defined as a composite of myocardial infarction, stroke, or all-cause mortality. The primary kidney outcome was major adverse kidney events (MAKE), defined as a decline in estimated glomerular filtration rate of more than 50% from baseline or progression to end-stage kidney disease. Baseline characteristics were balanced across treatment groups using matching weights, and weighted Cox proportional hazards models were applied to estimate associations between treatment and outcomes.
RESULTS: The final cohort comprised 119,810 patients initiating GLP-1 RAs (n=17,416), sodium-glucose cotransporter-2 inhibitors (SGLT-2i; n=19,863), dipeptidyl peptidase-4 inhibitors (DPP-4i; n=6,880), insulin (n=41,349), α-glucosidase inhibitors (AGIs; n=8,214), thiazolidinediones (TZDs; n=1,029), and meglitinides (n=3,510). Compared with GLP-1 RAs, significantly higher risks of MACE were observed among users of SGLT-2i (HR=1.118, P=0.002), insulin (HR=1.271, P<0.001), AGIs (HR=1.409, P<0.001), and meglitinides (HR=1.163, P=0.010), while no significant differences were found versus DPP-4i or TZDs. For kidney outcomes, SGLT-2i were associated with a significantly lower risk of MAKE compared with GLP-1 RAs (HR=0.581, P=0.005). In contrast, significantly higher risks of MAKE were observed among users of DPP-4i (HR=1.778, P=0.007), insulin (HR=2.850, P<0.001), and meglitinides (HR=5.416, P<0.001). No statistically significant differences were observed when GLP-1 RAs were compared with AGIs or TZDs.
CONCLUSIONS: GLP-1 RAs showed superior cardiovascular effectiveness and greater kidney protection than most glucose-lowering agents, except SGLT-2 inhibitors.
METHODS: This retrospective cohort study utilized electronic medical records from a large healthcare platform in Eastern China. Adult patients with T2DM who initiated a second-line antidiabetic medication after prior metformin monotherapy or no antidiabetic treatment between January 2018 and October 2024 were included. The primary cardiovascular outcome was major adverse cardiovascular events (MACE), defined as a composite of myocardial infarction, stroke, or all-cause mortality. The primary kidney outcome was major adverse kidney events (MAKE), defined as a decline in estimated glomerular filtration rate of more than 50% from baseline or progression to end-stage kidney disease. Baseline characteristics were balanced across treatment groups using matching weights, and weighted Cox proportional hazards models were applied to estimate associations between treatment and outcomes.
RESULTS: The final cohort comprised 119,810 patients initiating GLP-1 RAs (n=17,416), sodium-glucose cotransporter-2 inhibitors (SGLT-2i; n=19,863), dipeptidyl peptidase-4 inhibitors (DPP-4i; n=6,880), insulin (n=41,349), α-glucosidase inhibitors (AGIs; n=8,214), thiazolidinediones (TZDs; n=1,029), and meglitinides (n=3,510). Compared with GLP-1 RAs, significantly higher risks of MACE were observed among users of SGLT-2i (HR=1.118, P=0.002), insulin (HR=1.271, P<0.001), AGIs (HR=1.409, P<0.001), and meglitinides (HR=1.163, P=0.010), while no significant differences were found versus DPP-4i or TZDs. For kidney outcomes, SGLT-2i were associated with a significantly lower risk of MAKE compared with GLP-1 RAs (HR=0.581, P=0.005). In contrast, significantly higher risks of MAKE were observed among users of DPP-4i (HR=1.778, P=0.007), insulin (HR=2.850, P<0.001), and meglitinides (HR=5.416, P<0.001). No statistically significant differences were observed when GLP-1 RAs were compared with AGIs or TZDs.
CONCLUSIONS: GLP-1 RAs showed superior cardiovascular effectiveness and greater kidney protection than most glucose-lowering agents, except SGLT-2 inhibitors.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO170
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)