Abstract
BackgroundCurrent evidence about the cardiovascular safety of glucagon-like peptide-1 receptor agonist (GLP-1ra) possesses limited generalizability to real-world patients with type 2 diabetes (T2D) in usual practice. This study aimed to investigate the comparative cardiovascular safety of GLP-1ra in comparisons with dipeptidyl peptidase-4 inhibitor (DPP-4i), sulfonylurea (SU), and insulin in a real-world population with T2D.MethodsAdults with newly-diagnosed T2D were identified from Taiwan’s National Health Insurance Research Database in 2003–2014. A prevalent new-user cohort design was adopted to include a broad representation of real-world T2D patients being treated with GLP-1ra. The between-group comparability of baseline patient characteristics was achieved by matching on (1) initiation time of study drugs, (2) prior exposure to glucose-lowering agents, and (3) diabetes severity and complications, comorbidities, and concomitant cardiovascular medications using propensity scores. The primary outcome was a composite of cardiovascular disease (CVD) events and assessed up to the end of 2015. Cox modeling was employed to assess the association between study drugs and outcomes.ResultsA total of 3195 GLP-1ra stable users was identified in 2011-2014. 1893, 1829, and 1367 GLP-1ra stable users were 1:1 matched to DPP-4i, SU and insulin users, respectively. Compared to DPP-4i, SU and insulin, the use of GLP-1ra was associated with a lower risk of composite CVD events [hazard ratio (95% confidence interval) 0.73 (0.57–0.96), 0.76 (0.57–1.00), and 0.81 (0.62–1.07), respectively]. Subgroup analyses revealed that GLP-1ra versus DPP-4i yielded a greater cardiovascular benefit in those without established CVD versus those with established CVD.ConclusionsThis comparison study extends the supporting evidence for the cardiovascular safety of GLP-1ra to a broad spectrum of real-world T2D patients using GLP-1ra.
Highlights
Current evidence about the cardiovascular safety of glucagon-like peptide-1 receptor agonist (GLP-1ra) possesses limited generalizability to real-world patients with type 2 diabetes (T2D) in usual practice
Background early initiation of glucagon-like peptide-1 receptor agonist (GLP-1ra) is recommended for patients with type 2 diabetes (T2D) who have established cardiovascular diseases (CVDs) or need to minimize hypoglycemia or promote weight loss [1], it is commonly observed that GLP-1ra is initiated in the later treatment course
There was no significant difference in baseline patient characteristics between the study groups after the matching, except that the GLP-1ra users were significantly younger than insulin users (Table 1)
Summary
Current evidence about the cardiovascular safety of glucagon-like peptide-1 receptor agonist (GLP-1ra) possesses limited generalizability to real-world patients with type 2 diabetes (T2D) in usual practice. Yang et al Cardiovasc Diabetol (2020) 19:83 of T2D in real-world practice settings (especially after treatment failure under dual or triple glucose-lowering agents [GLAs] [2,3,4,5,6]). This may be due to several reasons. Considering the high acquisition cost of GLP-1ra, Taiwan’s National Health Insurance program implements a restricted reimbursement policy to limit the use of GLP-1ra only for those who have already failed to monotherapy with metformin or sulfonylurea, or to dual therapy with metformin and sulfonylurea
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