In cardiovascular outcome trials among adults with type 2 diabetes (T2D), sodium-glucose co-transporter 2 inhibitors (SGLT-2i) have shown therapeutic promise, including reduced risk of hospitalization for heart failure compared to placebo.
However, SGLT-2i have mainly been evaluated as a second-line treatment -; metformin is generally given as a first-line, antidiabetic treatment. In a new study, researchers from the Brigham compared cardiovascular outcomes among adults with T2D who initiated first-line treatment with either metformin or SGLT-2i. For the study, 8,613 patients treated with SGLT-2i were matched to 17,226 patients treated with metformin.
The authors found that patients receiving SGLT-2i showed a similar risk for myocardial infarction, stroke, and all-cause mortality, and a lower risk for hospitalization for heart failure compared with patients who received metformin. The risk for adverse events was similar except for an increased risk for genital infections compared with those receiving metformin.
Our results suggest that SGLT-2i may be considered as first-line treatment for patients with T2D and cardiovascular disease or who are at increased risk for cardiovascular events. However, more evidence from randomized clinical trials or observational studies will help us to identify patients who would benefit most from using SGLT-2i as first-line type 2 diabetes treatment."
HoJin Shin, BPharm, PhD, lead author, Division of Pharmacoepidemiology and Pharmacoeconomics
Shin, H., et al. (2022) Cardiovascular Outcomes in Patients Initiating First-Line Treatment of Type 2 Diabetes With Sodium–Glucose Cotransporter-2 Inhibitors Versus Metformin. Annals of Internal Medicine. doi.org/10.7326/M21-4012.