SGLT2 vs DPP4 Medications Associated with Lower Heart Failure Hospitalizations in Type 2 Diabetes

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Hospital Bed Nurses Staff
Patients with type 2 diabetes who received sodium-glucose co-transporter 2 inhibitors vs dipeptidyl peptidase-4 inhibitors had a lower risk for heart failure hospitalizations.

Hospital admissions for heart failure (HF) are lower in older patients with type 2 diabetes (T2D) treated with sodium-glucose co-transporter-2 (SGLT2) vs dipeptidyl peptidase-4 (DPP4) inhibitors, according to a real-world, retrospective analysis published in Cardiovascular Diabetology.1

The researchers retrospectively examined outcomes in patients with T2D using a national commercially insured claims database, specifically comparing patients receiving either SGLT2 (n=4899) or DPP4 (n=9798) medications. Primary outcome, assessed with Cox regression models, was HF hospitalization.

Following risk adjustment, patients receiving SGLT2 inhibitors had significantly lower rates of hospitalization due to HF compared with DPP4 users (2.0% vs 3.1%, respectively; adjusted hazard ratio [aHR], 0.68; 95% CI, 0.54-0.86; P =.001). In patients aged 65 years or older, HF hospitalization rates were also lower in the SGLT2 cohort vs the DPP4 cohort (4.7% vs 9.1% DPP4; aHR, 0.60; 95% CI, 0.41-0.87; P =.008).

In addition, patients presenting with a diabetes complication who also received SGLT2 medications had lower rates of hospital admissions for HF compared with the DPP4 group (4.5% vs 6.9%; aHR, 0.68; 95% CI, 0.52-0.90; P =.006).

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Because this study compared outcomes of nonrandomized treatment groups, there may have been potential selection bias. Also, there was a lack of information regarding diabetes onset or duration in claims data, which may have affected outcomes.

To establish greater clarity on this study’s findings, the investigators commented that future studies “could focus on comparisons of the SGLT2 class with other antidiabetic drug classes to further confirm the potential class level effect of SGLT2 drugs.”


Gautam S, Agiro A, Barron J, Power T, Weisman H, White J. Heart failure hospitalization risk associated with use of two classes of oral antidiabetic medications: an observational, real-world analysis. Cardiovasc Diabetol. 2017;16(1):93. doi:10.1186/s12933-017-0575-x