OBJECTIVES : To compare the risk of heart failure hospitalizations in type 2 diabetes patients newly receiving sodium glucose co-transporter 2 (SGLT2) inhibitors, dapagliflozin vs. empagliflozin.

METHODS : Our retrospective cohort study draws upon data from a multi-institutional database (Chang Gung Research Database, CGRD) containing the electronic medical records of approximately 1.3 million patients (6% of the Taiwanese population). Included were adult type 2 diabetes patients who had been newly prescribed SGLT2 inhibitors between 2016 and 2017, and these were followed up from initiation of SGLT2 inhibitors until their heart failure hospitalizations, last clinical visit or death before March 31, 2019. We used multi-variate Cox proportional hazard modeling, with adjustment for age of patient, gender, baseline glycemic controls, renal functions, co-morbidities and concomitant use of medication.

RESULTS : The database yielded 14,458 new users of SGLT2 inhibitors, with mean age 59.3 (SD 11.8) years old. Of these, 42.6% were female; 45.1% were newly receiving dapagliflozin. The total included amount of dapagliflozin use was 12,974 person-years, while total empagliflozin use was 15,413 person-years. New users of dapagliflozin were at lower risk of heart failure hospitalizations (adjusted HR: 0.70; 95% CI: 0.53-0.93) when compared to new users of empagliflozin. Falsification testing showed dapagliflozin and empagliflozin carried a similar risk of atrial fibrillation hospitalizations (adjusted HR: 1.04; 95% CI: 0.73-1.47).

CONCLUSIONS : Patients with type 2 diabetes newly receiving dapagliflozin were at lower risk of heart failure hospitalizations when compared to empagliflozin users. Clinicians should be cognizant of the comparative differences between SGLT2 inhibitors when deciding medications for patients with type 2 diabetes.