Inhibitors of SGLT2 and DPP-4 have similar risk of below-knee amputation
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Inhibitors of SGLT2 and DPP-4 have similar risk of below-knee amputation Treatment with sodium-glucose cotransporter 2 (SGLT2) inhibitors was not associated with increased risk of belowknee amputations compared with dipeptidyl peptidase 4 (DPP-4) inhibitors in patients with type-2 diabetes according to findings of a large observational study published in the journal, Diabetes Care. The study analysed data from administrative health care databases from seven Canadian provinces and the UK using a prevalent new-user design and time-conditional propensity scores. The study cohort consisted of 207 817 SGLT2 inhibitor users matched to 207 817 DPP-4 inhibitor users by their exposure set (user type – incident or prevalent, level of antidiabetic therapy, time on DPP-4 inhibitors, prior use of glucagon-like peptide-1receptor agonists, and within 120 days of the SGLT2 inhibitor prescription). The amputation rate, determined during a mean exposed follow-up time of 11 months, was 1.3 per 1000 person-years for users of SGLT2 inhibitors versus 1.5 per 1000 person-years for users of DPP-4 inhibitors. There was no significant increase in risk of incident below-knee amputations with SGLT2 inhibitors compared with DPP-4 inhibitors (HR 0.88; 95% CI 0.71-1.09). Similar results were also found in stratified analyses of age, sex, prior use of insulin, or specific SGLT-2 inhibitor. Among prevalent new users of SGLT2 inhibitors there was a trend toward an increased risk of incident below-knee amputation compared with DPP-4 inhibitor users (HR 1.29; 95% CI 0.97–1.70). Previous studies assessing the risk of amputation with SGLT2 inhibitor use have produced heterogeneous results. The current study is the largest observational study to examine this potential safety issue of SGLT2 use. With the prevalent new-user design, patients who switched to or added an SGLT2 inhibitor to their treatment regimen were included in the study cohort, making these findings relevant to the realities of clinical practice. The authors acknowledged that the duration of follow-up was modest and suggest that "future studies with a longer duration of follow-up are needed to determine whether long-term use of SGLT2 inhibitors is associated with below-knee amputation risk". Sodium-Glucose Cotransporter 2 Inhibitors and the Risk of Below-Knee Amputation: A Multicenter Observational Study Diabetes Care : 31 Aug 2020. Available from: URL: 803500228 https://care.diabetesjournals.org/content/diacare/early/2020/08/03/dc20-0267.full.pdf
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Reactions 5 Sep 2020 No. 1820
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