Comparative effectiveness of sodium-glucose co-transporter 2 inhibitors and dipeptidyl peptidase-4 inhibitors on cardiorenal function and treatment adherence: A Prevalent New-User Design Study in tertiary hospitals

Data on the long-term effects comparing sodium-glucose co-transporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP4i) are scarce, especially from middle-income countries. To examine the effects of SGLT2i and DPP4i on the cardiorenal function and treatment adherence for people with type 2 diabetes (T2D) using prevalent new-user design in real-world setting. We conducted a retrospective cohort study in two tertiary hospitals in Malaysia and matched T2D patients initiated on SGLT2i or DPP4i from 2010 to 2021 using time-conditional propensity score. Outcomes of interest included cardiovascular and renal outcomes, as well as clinical lab outcomes, adherence and non-persistence. The hazard ratios for cardiorenal outcomes was inferred using Cox proportional hazards model. The cohort included 1528 patients, with 406 SGLT2i users matched with 406 DPP4i users. Over a median follow-up of 1.52 years, no differences in cardiorenal outcomes were observed. Patients initiated with SGLT2i had lower HbA1c at 12-month (-0.79%,p<0.001) compared to DPP4i (-0.49%,p<0.05; difference:-0.30%,p<0.05). No differences in the renal, lipid, weight and blood pressure parameters were observed between both groups. Higher medication persistence was noted among SGLT2i users compared to DPP4i users (92% vs 87%,P=0.03). Both medications were comparable in exerting distinct effects on cardiorenal risk factors, with better HbA1c control and medication persistence among SGLT2i users. The long-term cardiorenal outcomes remains undetermined.