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Abstract: PO1011

Comparative Effectiveness of SGLT2 Inhibitors, GLP1 Receptor Agonists, DPP4 Inhibitors, and Sulfonylureas on Risk of Kidney Outcomes: Emulation of a Target Trial Using Healthcare Databases

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Xie, Yan, Clinical Epidemiology Center, VA Saint Louis healthcare system, St. Louis, Missouri, United States
  • Bowe, Benjamin Charles, Clinical Epidemiology Center, VA Saint Louis healthcare system, St. Louis, Missouri, United States
  • Gibson, Andrew K., Clinical Epidemiology Center, VA Saint Louis healthcare system, St. Louis, Missouri, United States
  • McGill, Janet B., Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States
  • Yan, Yan, Clinical Epidemiology Center, VA Saint Louis healthcare system, St. Louis, Missouri, United States
  • Maddukuri, Geetha S., Nephrology Section, Medicine Service, VA Saint Louis Health Care System, St. Louis, Missouri, United States
  • Al-Aly, Ziyad, Clinical Epidemiology Center, VA Saint Louis healthcare system, St. Louis, Missouri, United States
Background

The comparative effectiveness of SGLT2i, GLP1, DPP4, and sulfonylureas on risk of kidney outcomes among people with type 2 diabetes mellitus is not known.

Methods

We built a cohort of 216,558 US Veterans initiated on SGLT2i, GLP1, DPP4, or sulfonylureas and followed them for up to 3 years. The outcome was defined as the risk of the major adverse kidney events (MAKE) of estimated glomerular filtration rate (eGFR) decline >50%, end stage kidney disease, or all-cause mortality. Risks were estimated using survival models adjusted for pre-defined covariates as well as covariates identified by a high-dimensional variable selection algorithm through application of generalized propensity scores.

Results

During follow up, there were 14612 (6.75%) MAKEs. Adjusted KM curve for risk of MAKE across treatment arms are presented. Compared to those treated with sulfonylurea, treatment with SGLT2i, GLP1, and DPP4 was associated with lower risk of MAKE (HR=0.68 (0.63-0.74), HR=0.72 (0.67-0.77), and HR=0.90 (0.86-0.95), respectively). Both SGLT2i and GLP1 had lower risk of MAKE than DPP4 (HR=0.76 (0.70-0.82), and HR=0.79 (0.74-0.85), respectively). The associations were consistent regardless of metformin use at baseline. Analyses by eGFR category suggested that compared to the sulfonylureas arm, those in the SGLT2i and GLP1 arms exhibited lower risk of MAKE in all eGFR categories. Compared to DPP4, both SGLT2i and GLP1 exhibited reduced risk of MAKE in eGFR >90 to ≥60, <60 to ≥45, and <45 ml/min/1.73 m2.

Conclusion

Among patients with diabetes mellitus type 2, treatment with SGLT2i or GLP1 compared to DPP4 or sulfonylureas was associated with lower risk of adverse kidney outcomes.

Funding

  • Veterans Affairs Support