According to American Diabetes Association, the use of SGLT2 inhibitors is recommended after the failure of first-line metformin treatment for patients with type 2 diabetes and comorbidities such as atherosclerotic cardiovascular diseases, heart failure, and chronic kidney disease. Hence, several studies are being conducted to find the effectiveness and safety associated with the use of SGLT2 inhibitors vs other glucose-lowering agents. dipeptidyl peptidase-4 inhibitors (DPP4is) aremost commonly used as a comparator drug for an SGLT2 inhibitor. They are oral glucose-lowering agents for T2D patients having a neutral effect on the risk of developing hypoglycemia, CVDs, or gaining weight.  

The study evaluated the effect of SGLT2 inhibitor vs DPP4 in a large Asian cohort with type 2 diabetes followed by a systematic review of the results from the Asian perspective. Asian populations are usually underrated in such studies and have different parameter values in comparison to the Caucasian population such as the early onset of T2D, higher risk of stroke and CKD, and lifestyle differences. The information about the new users of SGLT2 inhibitors and DDP4 inhibitors was collected from Taiwan’s National Health Insurance Research Database. The primary outcome was set as hospitalization for heart failure, or a three-point major adverse cardiovascular event, namely myocardial infarction, stroke, or cardiovascular death. The secondary outcomes were identified as all-cause death, CKD, amputation, hypoglycemia, etc. Sub distribution hazard model was used to evaluate clinical outcomes associated with the administered treatment regimen. 

A total of 21,329 cases were analyzed and the results were recorded in terms of hazard ratios as followed: SGLT2i vs DPP4i showed a lower risk of hospitalization for heart failure (0.52), three-point major adverse cardiovascular event (0.62), all-cause death (0.57), CKD (0.46), amputation (0.64), hypoglycemia (0.54) respectively. Conclusively, the results showed a significant decrease in the risk of developing primary or secondary outcomes after the administration of SGLT2i in comparison to DPP4i. 

Yang CT et al., Front Endocrinol (Lausanne). 2022 Mar, doi: 10.3389/fendo.2022.836365