Type 2 diabetes: early initiation of SGLT2i is linked to better CV outcomes

Why is this important?

• Whether patients with T2D who have risk factors for CVAS but no established CVD would benefit from SGLT2i is unclear.

Methodology

• The study included 1,685 patients who received a first prescription for an SGLT2i within 12 months, matched according to propensity scores to 1,685 patients who received a first prescription after 12 months, divided into 3 groups: known MCVAS, risk factors cardiovascular (CV), and no MCVAS or risk factors.
• Primary endpoint: three-component major adverse cardiovascular events (MCAEs) defined as nonfatal cerebrovascular accident (CVA), nonfatal myocardial infarction (MI), and CV death.
• Funding: no funding was disclosed.

Principle results

• During a median follow-up of 2.8 years, the hazard ratio (RR) of MCEI for initiation of SGLT2i at 12 months, compared to initiation at 12 months, was 0.27 ( confidence interval [IC] at 95%: 0.17–0.42).
• Similar results were seen in subgroup analyzes of patients with CVD risk factors or known CVD, but not in those without risk factors or CVD (P_interaction = 0,001).
• The initiation of SGLT2i was associated with a reduction in MI and CV death, but not ischemic stroke.
• MCVAS and/or risk factors alone and delayed use of SGLT2i contributed to additional ACE rates of 5.87 and 0.13 cases per 1000 person-years, respectively.

Limits

• “Early” initiation was set arbitrarily at 12 months.
• No assessment of persistence of SGLT2i use.
• Potential residual confounders.
• Propensity score matching led to a reduction in sample size.