Abstract: TH-PO1054
Insulin Glargine and SGLT2 Inhibitors Have Higher Risk of Major Adverse Cardiovascular Events (MACE) Compared with Glucagon-Like Peptide 1 Receptor Agonists (GLP-1 RAs) in a National Cohort of Veterans with Type 2 Diabetes (T2D) and CKD
Session Information
- CKD: Therapeutic Advances
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Katkam, Niharika, University of Utah Health, Salt Lake City, Utah, United States
- Sarwal, Amara, University of Utah Health, Salt Lake City, Utah, United States
- Hartsell, Sydney Elizabeth, University of Utah Health, Salt Lake City, Utah, United States
- Singh, Ravinder, University of Utah Health, Salt Lake City, Utah, United States
- Wei, Guo, University of Utah Health, Salt Lake City, Utah, United States
- Boucher, Robert E., University of Utah Health, Salt Lake City, Utah, United States
- Chakravartula, Akhil Ramanujam, University of Utah Health, Salt Lake City, Utah, United States
- Shen, Jincheng, University of Utah Health, Salt Lake City, Utah, United States
- Nevers, Mckenna R., University of Utah Health, Salt Lake City, Utah, United States
- Drakos, Stavros, University of Utah Health, Salt Lake City, Utah, United States
- Greene, Tom, University of Utah Health, Salt Lake City, Utah, United States
- Beddhu, Srinivasan, University of Utah Health, Salt Lake City, Utah, United States
Background
Insulin glargine(IG) is commonly used for glycemic control in persons with T2D and CKD. However, there is limited data on direct comparisons between IG and newer agents like GLP1-RA and SGLT2i on MACE in CKD.
Methods
We used an active comparator, new user design to compare the effects of initiating IG, GLP1-RA, or SGLT2i on MACE between 1/1/18 to 12/31/21 in veterans with T2D on metformin. Prescriptions for these agents between 1/1/08 to 1/1/18 was an exclusion. Follow-up was until 3/31/23. Application of inverse probability weighting(IPW) for each of the pairwise comparisons resulted in balance of baseline variables including demographics, comorbidity, duration of T2D, BP, BMI, A1C, eGFR and meds. MACE was defined as ER visit/ hospitalization for MI, stroke or HF. IPW Cox models with further adjustment for baseline covariates, were used to related the three drug initiation groups to MACE, all-cause mortality(ACM) or composite of MACE/ACM in those without and with CKD (eGFR < 60).
Results
33.7% were initiated on IG, 13.7% on GLP1-RA, and 52.6% on SGLT2i. 16.5% had CKD. We observed 15461 MACE events/ 352837person-years in non-CKD and 5304 events/ 61578person-years in CKD.11325 deaths/ 377116person-years in non-CKD and 3943 deaths/70343person-years in CKD. IPW Cox model results are summarized in Table.
Conclusion
In CKD, initiation of IG was associated with higher risk of MACE and ACM compared to GLP1-RA and higher risk of ACM compared to SGLT2i. Compared to GLP1-RA, SGLT2i had higher risk of MACE in CKD. Randomized controlled trials comparing SGLT2i and GLP1-RA in CKD are warranted.
| MACE | Non-CKD HR (95% CI) | CKD HR (95% CI) |
| IG vs GLP1-RA | 1.27 (1.19, 1.34) | 1.14 (1.04, 1.25) |
| IG vs SGLT2i | 1.10 (1.05, 1.14) | 1.03 (0.96, 1.11) |
| SGLT2i vs GLP1-RA | 1.16 (1.09, 1.23) | 1.13 (1.03, 1.24) |
| MACE/ ACM | ||
| IG vs GLP1-RA | 1.44 (1.37, 1.51) | 1.25 (1.16, 1.36) |
| IG vs SGLT2i | 1.28 (1.24, 1.32) | 1.18 (1.11, 1.25) |
| SGLT2i vs GLP1-RA | 1.13 (1.07, 1.19) | 1.08 (1.00, 1.18) |
| ACM | ||
| IG vs GLP1-RA | 1.72 (1.60, 1.85) | 1.42 (1.27, 1.58) |
| IG vs SGLT2i | 1.59 (1.51, 1.67) | 1.43 (1.32, 1.56) |
| SGLT2i vs GLP1-RA | 1.11 (1.03, 1.19) | 1.01 (0.89, 1.13) |
Funding
- NIDDK Support