OBJECTIVES : The aims of this study were to examine the occurrence of cardiovascular (CV), metabolic (MB), and renal (RL) outcomes among type 2 diabetes (T2D) patients treated with sodium-glucose cotransporter-2 (SGLT2) compared to dipeptidyl peptidase-4 (DPP4) inhibitors, and to explore whether race modified the association.

METHODS : T2D patients were identified in a US-based EMR network. Adult patients (aged 20+) were required to have an HbA1c of 6.5% or greater in the year prior to their first T2D diagnosis. The index date was the first record of a SGLT-2 or DPP-4 inhibitor. Incident CV, MB, and RL outcomes were examined in the 5 years following the index event, adjusting for baseline confounding using a 1:1 matched propensity score method. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for the total population and for Black and White patients. Patient characteristics were defined by ICD-9/10, RxNorm, and LOINC terms.

RESULTS : Before matching, 24,176 and 51,548 patients were identified with SGLT2 and DDP4 treatment, respectively. On average, SGLT2 patient were younger (56 vs 61) and more likely to be male (55% vs 49%) After matching, the study population included 24,156 in both the SGLT2 and DPP4 groups. SGLT2 compared to DPP4 use was associated with 0.93 (0.92,0.95) times the risk of dyslipidemia, 0.68 (0.66,0.70) times the risk of chronic kidney disease, 0.96 (0.95,0.96) times the risk of hypertension, 0.60 (0.54,0.65) times the risk of stroke, 0.45 (0.38,0.52) times the risk of acute kidney failure (AKF), 0.74 (0.70,0.79) times the risk of heart failure, 0.76 (0.69,0.85) times the risk of myocardial infarction, and 0.76 (0.63,0.92) times the risk of unstable angina. Race was not a modifier.

CONCLUSIONS : Although SGLT2 compared to DPP4 treatment resulted in fewer CV, MB, and RL outcomes, there was no difference between Black and White patients.