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Video

Oral Presentation

Session: Effectiveness of Antidiabetic Treatments

Sodium-Glucose Cotransporter-2 Inhibitors, and Glucagon-Like Peptide-1 Receptor Agonists, and the Risk of Macrovascular, and Microvascular Complications Among Patients with Type 2 Diabetes and Non-Alcoholic Fatty Liver Disease

Friday, August 25, 2023
2:30 PM – 2:45 PM ADT
Location: MR109
Publication Number: 58

    Presenting Author(s)

  • Sungho Bea, PharmD

    Doctoral student
    School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
    Suwon, Republic of Korea

    Slides
Background: The association of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA) and the risk of diabetic complications among patients with concomitant non-alcoholic fatty liver disease (NAFLD) is not fully understood. Moreover, it remains unclear if the risk of diabetic complications varies by NAFLD stage.

Objectives: Our objective was to investigate the effectiveness of SGLT2i and GLP1RA compared to that of dipeptidyl peptidase-4 inhibitors (DPP4i) among patients with type 2 diabetes stratified by NAFLD status.

Methods: We assembled two distinct new-user, active-comparator cohorts using nationwide health insurance claims databases from South Korea from 2013 to 2020. The first compared SGLT2i versus DPP4i; the second compared GLP1RA versus DPP4i. Each cohort was stratified by NAFLD stage using fatty liver index (FLI) (without NAFLD, 60; with NAFLD, 60≤FLI), a validated surrogate indicator of NAFLD. Effectiveness outcomes were major adverse cardiovascular events (MACE), a composite endpoint of hospitalization for myocardial infarction, hospitalization for stroke, and cardiovascular death; and hospitalization for heart failure (HHF). Patients were followed from the day after initiation of the cohort entry drug until the occurrence of a study outcome, drug discontinuation (or switching), death, or end of the study date, whichever occurred first. We applied 1:1 propensity score (PS) matching to calculate hazard ratios (HRs) using Cox models. Also, Wald test was applied to assess the effect of heterogeneity by NAFLD.

Results: After 1:1 PS matching, the first cohort included 70,219 pairs of new users of SGLT2i and DPP4i; the second cohort included 17,443 pairs of new users of GLP1RA and DPP4i. Compared with DPP4i, SGLT2i were associated with a lower rate of MACE (HR 0.78, 95% CI 0.71 to 0.85) and HHF (0.62, 0.48 to 0.81). GLP1RA were associated with a decreased rate of MACE (0.49, 0.39 to 0.62), but were not associated with the rate of HHF (0.64, 0.39 to 1.07). Stratified analysis by NAFLD status yielded consistent results among both of SGLT-2i (MACE, with NAFLD:0.73, 0.62 to 0.86 vs without NAFLD:0.81, 0.72 to 0.91; HHF, with NAFLD:0.76, 0.49 to 1.17 vs without NAFLD:0.56, 0.40 to 0.78) and GLP1RA (MACE, with NAFLD:0.49, 0.32 to 0.77 vs without NAFLD:0.49, 0.37 to 0.65; HHF, with NAFLD:0.82, 0.38 to 1.76 vs without NAFLD:0.54, 0.27 to 1.06).

Conclusions: This large, population-based cohort study demonstrates cardiovascular effectiveness of GLP1RA and SGLT2i are present among patients with type 2 diabetes with and without NAFLD. This study highlights the potential of SGLT2i and GLP1RA as promising options for glycaemic control, regardless of NAFLD status.