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Association of Renal and Cardiovascular Safety With DPP-4 Inhibitors vs. Sulfonylureas in Patients With Type 2 Diabetes and Advanced Chronic Kidney Disease.
Clin Pharmacol Ther. 2021 08; 110(2):464-472.CP

Abstract

This study assessed the effects of dipeptidyl peptidase-4 inhibitors (DPP4is) vs. sulfonylureas (SUs) on composite renal, cardiovascular, and hospitalized hypoglycemia outcomes in type 2 diabetes (T2D) patients with advanced chronic kidney disease (CKD) who were underrepresented in previous clinical studies. The National Health Insurance Research Database was utilized. Patients with T2D and advanced CKD (stages 3b-5) with stable use of DPP4is or SUs were identified during 2011-2015 and followed until death or December 31, 2016. The primary outcome was the composite renal outcome. Secondary outcomes included hospitalized heart failure (HHF), major adverse cardiovascular event (MACE), hospitalized hypoglycemia, and all-cause death. Subdistribution hazard models were employed to assess treatment effects on clinical outcomes. A total of 1,204 matched pairs of DPP4i and SU users were analyzed. Compared with SUs, DPP4is had no significant difference in the risks of the composite renal outcome, HHF, and three-point and four-point MACE (hazard ratios (95% confidence intervals): 1.10 (0.93-1.31), 1.11 (0.95-1.30), 0.97 (0.79-1.19), and 1.08 (0.94-1.24), respectively), but reduced risks of hospitalized hypoglycemia (0.53 (0.43-0.64)) and all-cause death (0.71 (0.53-0.96)). In conclusion, among patients with T2D and advanced CKD, the use of DPP4is vs. SUs was associated with comparable safety profiles on renal and cardiovascular outcomes, and reduced risks of hospitalized hypoglycemia and all-cause death. DPP4is may be preferred for patients with T2D and advanced CKD, and the regular monitoring on cardiac function remains crucial among this population who are at a higher risk of HHF.

Authors+Show Affiliations

Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan.Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33866549

Citation

Yang, Chun-Ting, et al. "Association of Renal and Cardiovascular Safety With DPP-4 Inhibitors Vs. Sulfonylureas in Patients With Type 2 Diabetes and Advanced Chronic Kidney Disease." Clinical Pharmacology and Therapeutics, vol. 110, no. 2, 2021, pp. 464-472.
Yang CT, Lin WH, Li LJ, et al. Association of Renal and Cardiovascular Safety With DPP-4 Inhibitors vs. Sulfonylureas in Patients With Type 2 Diabetes and Advanced Chronic Kidney Disease. Clin Pharmacol Ther. 2021;110(2):464-472.
Yang, C. T., Lin, W. H., Li, L. J., Ou, H. T., & Kuo, S. (2021). Association of Renal and Cardiovascular Safety With DPP-4 Inhibitors vs. Sulfonylureas in Patients With Type 2 Diabetes and Advanced Chronic Kidney Disease. Clinical Pharmacology and Therapeutics, 110(2), 464-472. https://doi.org/10.1002/cpt.2262
Yang CT, et al. Association of Renal and Cardiovascular Safety With DPP-4 Inhibitors Vs. Sulfonylureas in Patients With Type 2 Diabetes and Advanced Chronic Kidney Disease. Clin Pharmacol Ther. 2021;110(2):464-472. PubMed PMID: 33866549.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Renal and Cardiovascular Safety With DPP-4 Inhibitors vs. Sulfonylureas in Patients With Type 2 Diabetes and Advanced Chronic Kidney Disease. AU - Yang,Chun-Ting, AU - Lin,Wei-Hung, AU - Li,Lun-Jie, AU - Ou,Huang-Tz, AU - Kuo,Shihchen, Y1 - 2021/05/11/ PY - 2020/11/05/received PY - 2021/03/07/accepted PY - 2021/4/19/pubmed PY - 2021/8/28/medline PY - 2021/4/18/entrez SP - 464 EP - 472 JF - Clinical pharmacology and therapeutics JO - Clin Pharmacol Ther VL - 110 IS - 2 N2 - This study assessed the effects of dipeptidyl peptidase-4 inhibitors (DPP4is) vs. sulfonylureas (SUs) on composite renal, cardiovascular, and hospitalized hypoglycemia outcomes in type 2 diabetes (T2D) patients with advanced chronic kidney disease (CKD) who were underrepresented in previous clinical studies. The National Health Insurance Research Database was utilized. Patients with T2D and advanced CKD (stages 3b-5) with stable use of DPP4is or SUs were identified during 2011-2015 and followed until death or December 31, 2016. The primary outcome was the composite renal outcome. Secondary outcomes included hospitalized heart failure (HHF), major adverse cardiovascular event (MACE), hospitalized hypoglycemia, and all-cause death. Subdistribution hazard models were employed to assess treatment effects on clinical outcomes. A total of 1,204 matched pairs of DPP4i and SU users were analyzed. Compared with SUs, DPP4is had no significant difference in the risks of the composite renal outcome, HHF, and three-point and four-point MACE (hazard ratios (95% confidence intervals): 1.10 (0.93-1.31), 1.11 (0.95-1.30), 0.97 (0.79-1.19), and 1.08 (0.94-1.24), respectively), but reduced risks of hospitalized hypoglycemia (0.53 (0.43-0.64)) and all-cause death (0.71 (0.53-0.96)). In conclusion, among patients with T2D and advanced CKD, the use of DPP4is vs. SUs was associated with comparable safety profiles on renal and cardiovascular outcomes, and reduced risks of hospitalized hypoglycemia and all-cause death. DPP4is may be preferred for patients with T2D and advanced CKD, and the regular monitoring on cardiac function remains crucial among this population who are at a higher risk of HHF. SN - 1532-6535 UR - https://www.unboundmedicine.com/medline/citation/33866549/Association_of_Renal_and_Cardiovascular_Safety_With_DPP_4_Inhibitors_vs__Sulfonylureas_in_Patients_With_Type_2_Diabetes_and_Advanced_Chronic_Kidney_Disease_ DB - PRIME DP - Unbound Medicine ER -