Abstract 4368923: Impact of GLP-1 Receptor Agonist and SGLT2 Inhibitor Combination Therapy on Cardiovascular Events in Hospitalized Diabetic Patients: A National Inpatient Sample Analysis

Background: GLP-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter-2 inhibitors (SGLT2is) have both shown cardiovascular benefits in type 2 diabetes mellitus (T2DM). Recent 2024 studies show a synergistic impact of combination treatment; however, real-world evidence is lacking. Objective: To evaluate the impact of combined GLP-1 RA and SGLT2i therapy on cardiovascular outcomes among hospitalized patients with T2DM using a nationally representative dataset. Methods: We conducted a retrospective study using the National Inpatient Sample (2018-2020). Adult T2DM patients were divided into four categories: GLP-1RA alone, SGLT2i alone, combination treatment, and neither. Primary outcomes were myocardial infarction (MI), stroke, aggravation of heart failure (HF), and in-hospital death. Multivariable logistic regression took into account demographics, comorbidities, hospital factors, and concomitant treatments. Due to a lack of direct medication administration data in NIS, exposure was estimated using validated comorbidity and treatment pattern proxies. Results: Among the 245,761 patients, 3,194 (1.3%) received combo treatment. In comparison to non-users, the combination group had significantly decreased incidence of MI (aOR 0.71, 95% CI 0.64-0.79), stroke (aOR 0.76, 95% CI 0.66-0.89), HF aggravation (aOR 0.69, 95% CI 0.61-0.78), and in-hospital mortality. Combination treatment outperformed monotherapy in all subgroups. Conclusion: This research provides the first real-world, nationally representative evaluation of GLP-1 RA + SGLT2i combination treatment in hospitalized diabetes patients, revealing significant cardiovascular protection. These results corroborate previous trial data and recommend expanded use of dual treatment in high-risk people.