Effectiveness and Safety of Sodium-Glucose Cotransporter2 Inhibitors Added to Dual or Triple Treatment in Patients with Type2 Diabetes Mellitus.

Abstract

We evaluated the effectiveness and safety of sodium-glucose cotransporter2 inhibitor (SGLT2i) add-on treatment in patients with type2 diabetes mellitus (T2DM) in the real-world setting. This single-center retrospective study used the clinical database of Seoul National University Hospital in South Korea. Patients who received metformin monotherapy or combination therapy with ≥ 1 other oral hypoglycemic medication and had a baseline glycosylated hemoglobin (HbA1c) between 7.0% and 10.5% were included. Propensity score matching was applied between patients treated with and without SGLT2 inhibitors (SGLT2i and non-SGLT2i groups, respectively). Changes in HbA1c from baseline to week26 were compared between the SGLT2i and non-SGLT2i groups, and risk of adverse events (AE) were also assessed. A total of 1106 patients were included. At week26, HbA1c was significantly more reduced by 0.35 percentage points in the SGLT2i group than in the non-SGLT2i group (95%CI 0.30-0.41, P < 0.001). Likewise, the proportion of patients achieving HbA1c < 7% was also significantly higher (51.9% vs. 37.6%, P < 0.05) in the SGLT2i group than in the non-SGLT2i group. The risk of adverse events in the SGLT2i group was mostly comparable with those in the non-SGLT2i group except for diseases of the liver, pain, hypertensive diseases, and metabolic disorders, which showed significantly higher odds in the SGLT2i group. SGLT2i add-on treatment is an effective and safe therapeutic option for patients with T2DM in the real-world practice setting.