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Association of adverse respiratory events with sodium-glucose cotransporter 2 inhibitors versus dipeptidyl peptidase 4 inhibitors among patients with type 2 diabetes in South Korea: a nationwide cohort study.
- Source :
-
BMC medicine [BMC Med] 2023 Feb 10; Vol. 21 (1), pp. 47. Date of Electronic Publication: 2023 Feb 10. - Publication Year :
- 2023
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Abstract
- Background: Impaired respiratory function remains underrecognized in patients with type 2 diabetes (T2D), despite common pulmonary impairment. Meanwhile, there is little data available on the respiratory effects of sodium glucose cotransporter 2 inhibitors (SGLT2i). Hence, we examined the association between SGLT2i use and the risk of adverse respiratory events in a real-world setting.<br />Methods: We conducted a population-based, nationwide cohort study using an active-comparator new-user design and nationwide claims data of South Korea from January 2015 to December 2020. Among individuals aged 18 years or older, propensity score matching was done to match each new user of SGLT2is with dipeptidyl peptidase 4 inhibitors (DPP4is), with patients followed up according to an as-treated definition. The primary outcome was respiratory events, a composite endpoint of acute pulmonary edema, acute respiratory distress syndrome (ARDS), pneumonia, and respiratory failure. Secondary outcomes were the individual components of the primary outcome and in-hospital death. Cox models were used to estimate hazard ratios (HRs) and 95% CIs.<br />Results: Of 205,534 patient pairs in the propensity score matched cohort, the mean age of the entire cohort was 53.8 years and 59% were men, with a median follow-up of 0.66 years; all baseline covariates achieved balance between the two groups. Incidence rates for overall respiratory events were 4.54 and 7.54 per 1000 person-years among SGLT2i and DPP4i users, respectively, corresponding to a rate difference of 3 less events per 1000 person-years (95% CI - 3.44 to - 2.55). HRs (95% CIs) were 0.60 (0.55 to 0.64) for the composite respiratory endpoint, 0.35 (0.23 to 0.55) for acute pulmonary edema, 0.44 (0.18 to 1.05) for ARDS, 0.61 (0.56 to 0.66) for pneumonia, 0.49 (0.31 to 0.76) for respiratory failure, and 0.46 (0.41 to 0.51) for in-hospital death. Similar trends were found across individual SGLT2is, subgroup analyses of age, sex, history of comorbidities, and a range of sensitivity analyses.<br />Conclusions: These findings suggest a lower risk of adverse respiratory events associated with patients with T2D initiating SGLT2is versus DPP4is. This real-world evidence helps inform patients, clinicians, and guideline writers regarding the respiratory effects of SGLT2i in routine practice.<br /> (© 2023. The Author(s).)
- Subjects :
- Male
Humans
Middle Aged
Female
Cohort Studies
Hospital Mortality
Glucose
Sodium
Hypoglycemic Agents
Retrospective Studies
Diabetes Mellitus, Type 2 drug therapy
Diabetes Mellitus, Type 2 epidemiology
Dipeptidyl-Peptidase IV Inhibitors adverse effects
Pulmonary Edema chemically induced
Pulmonary Edema complications
Sodium-Glucose Transporter 2 Inhibitors adverse effects
Respiratory Insufficiency chemically induced
Respiratory Insufficiency complications
Subjects
Details
- Language :
- English
- ISSN :
- 1741-7015
- Volume :
- 21
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC medicine
- Publication Type :
- Academic Journal
- Accession number :
- 36765407
- Full Text :
- https://doi.org/10.1186/s12916-023-02765-2