All cause mortality in people with type 2 diabetes using SGLT-2 inhibitors compared to DPP4 inhibitors using the danish registries

Abstract Background The SGLT-2 inhibitors outcome trials such as EMPA-REG have had significant impact on the treatment and management of patients with type 2 diabetes. Using real world danish data simulating EMPA-REG criteria can demonstrate the efficacy of SGLT-2 in real world clinical settings. Aim The purpose of this study is to evaluate the efficacy of SGLT-2 in reducing all-cause mortality in people with type 2 diabetes (T2D) over a 5-year period, using real world data. We compared all cause mortality between those prescribed SGLT-2 and DPP4 inhibitors in a population resembling the EMPA-REG trial. DPP4 is selected as a comparator to SGLT-2 given it is known to be neutral with regards to cardiovascular disease (CVD). Methods Individuals were identified using Danish nationwide registries. This estimate was performed using in/exclusion criteria from EMPA-REG. We defined time zero as the first date the patient redeems either SGLT-2/DPP4. Individuals >=50 years of age with verified T2D and established CVD were included. CVD included myocardial infarctions, ischemic heart disease, stroke and heart failure. Individuals were only included if they had Hba1c at baseline > 53 mmol/mol (7.0%) The primary endpoint was all cause mortality. Survival was estimated using a Kaplan-Meier estimator in both arms. P values of less than 5% are considered significant. Results A total of 150.313 patients were identified to be on either DPP4-inhibitors or SGLT2 between 2012 and 2022. After applying EMPA-REG inclusion and exclusion criteria 15.461 patients remained (8518 on DPP4 and 6943 on SGLT2). The 5 year survival rate of SGLT2 and DPP4 was 0.780 and 0.657 respectively (p-value<0.0001). Conclusion In conclusion, we demonstrate, using EMPA-REG trial criteria in real-world data based on Danish nationwide registries, that five year mortality of people with T2D treated with SGLT-2 inhibitor was lower than those treated with DPP4 inhibitor.