1864-LB: Comparative Safety and Effectiveness of GLP-1RA and SGLT2i Use in Adults with Type 2 Diabetes in U.S. Clinical Practice

GLP-1 RA use has risen sharply, a shift prompted by trial evidence and guideline recommendations in T2D and use in obesity. To inform safe prescribing for T2D, this study assessed the real-world effects of GLP-1 RA and SGLT2i on the incidence of serious clinical events. Adults with T2D who initiated a GLP-1 RA or SGLT2i agent from 1/1/16 to 9/30/23 were identified from the Healthcare Integrated Research Database (HIRD), a large national US claims database. Outcomes included GI, psychiatric, hepatic and CV events, thyroid cancer and all-cause mortality. Inverse probability of treatment weighting was used to control confounding and incidence rates and rate ratios (RR) were estimated. Differences between new users of GLP-1 RA (n=311,574) and SGLT2i (n=255,146) were observed in age, sex, prevalent conditions (obesity, ASCVD, HF, CKD and anxiety) and insulin use. After weighting, characteristics were well balanced between groups. Rates and RR are displayed in the Table. Among serious events, only GI hospitalizations occurred more frequently in GLP-1 RA users, while acute liver injury was less common. Psychiatric events, thyroid cancer and all-cause mortality rates were similar between groups, as were CV event rates in these groups having broad heterogeneity in baseline CV risk. These real-world data complement trial data and should inform GLP-1 RA prescribing decisions in T2D.

Duke Scholars

Author Matthew Janik Crowley Medicine, Endocrinology, Metabolism, and Nutrition