We have detected that you are using an Ad Blocker. PracticeUpdate is free to end users but we rely on advertising to fund our site. Please consider supporting PracticeUpdate by whitelisting us in your ad blocker.
We have sent a message to the email address you have provided, . If this email is not correct, please update your settings with your correct address.
The email address you provided during registration, , does not appear to be valid. Please update your settings with a valid address before to continue using PracticeUpdate.
Welcome to PracticeUpdate! We hope you are enjoying access to a selection of our top-read and most recent articles. Please register today for a free account and gain full access to all of our expert-selected content.
You can find your saved items on your dashboard, in the "saved" tab.
You've recommended your first item
Your recommendations help us improve our content suggestions for you and other PracticeUpdate members.
You've subscribed to your first topic alert
What does that mean?
Each day, we'll check to see if new items have been published to the topics you're subscribed to, and we'll send you one email with all of the new items from that day.
We'll keep all topic alert notifications available on your dashboard for 30 days, to make sure you don't miss anything.
Lastly, whenever you have unread items in the topics you've subscribed to, the "Alerts" icon will light up in the main menu. Just click on the bell to see your five most-recent, unread notifications.
This retrospective cohort study assessed the real-world outcomes of people with diabetes treated with GLP-1 receptor agonists (GLP1RA) compared with those treated with SGLT2 inhibitors (SGLT2i) in terms of major adverse cardiovascular and limb events. A total of 287,091 patients were included in the analysis. The incidence rate of major adverse limb events (MALE) was significantly lower among the GLP1RA group than among the SGLT2i group (HR, 0.80) owing to a lower incidence of critical limb ischemia. The reduced risks of MALE were particularly noticeable in people with diabetic peripheral neuropathy.
GLP1RA use is associated with a significantly reduced risk of MALE compared with SGLT2i in people with diabetes, especially people with diabetic neuropathy.
This study aimed to assess the real-world outcomes of people with diabetes mellitus treated with glucagon-like peptide-1 receptor agonists (GLP1RAs) compared with those treated with sodium-glucose cotransporter 2 inhibitors (SGLT2is) in terms of major adverse cardiovascular and limb events. Peripheral artery disease is a common cause of morbidity in people with diabetes. Previous cardiovascular outcome trials have demonstrated the benefits of GLP1RAs and SGLT2is for reducing various cardiovascular events, but the safety and efficacy of these drugs on limb outcomes remain subject to debate and ambiguity.
A retrospective cohort study was conducted in which data were collected from the Taiwan National Health Insurance Research Database. In total, 379,256 individuals with diabetes receiving either GLP1RA or SGLT2i with treatment initiated between 1 May 2016 and 31 December 2019 were identified. The primary outcome was major adverse limb events (MALE), defined as the composite of newly diagnosed critical limb ischaemia, percutaneous transluminal angioplasty or peripheral bypass for peripheral artery disease, and non-traumatic amputation. The secondary outcome was major adverse cardiac events, which was a composite of cardiovascular death, non-fatal myocardial infarction and non-fatal ischaemic stroke. Other examined outcomes included death from any cause and hospitalisation for heart failure. Propensity score matching was performed at a 1:4 ratio between the GLP1RA and SGLT2i groups to mitigate possible selection bias.
A total of 287,091 patients were eligible for analysis, with 81,152 patients treated with SGLT2i and 20,288 patients treated with GLP1RA after matching. The incidence of MALE was significantly lower in the GLP1RA group than in the SGLT2i group (3.6 vs 4.5 events per 1000 person-years; subdistribution HR 0.80; 95% CI 0.67, 0.96), primarily due to a lower incidence of critical limb ischaemia. The reduced risks of MALE associated with GLP1RA use were particularly noticeable in people with diabetic peripheral neuropathy (subdistribution HR 0.66 vs 1.11; p for interaction 0.006).
In people with diabetes, GLP1RA use was associated with significantly reduced risks of MALE compared with SGLT2i within the first 2 years after initiation, especially among people with diabetic neuropathy.