The use of sodium-glucose co-transporter-2 inhibitors or glucagon-like peptide-1 receptor agonists versus sulfonylureas and the risk of lower limb amputations: a nation-wide cohort study

• DOI: 10.1186/s12933-023-01897-2
• Publication Date: 2023-06-29T17:02:00Z
• Authors: Nikki C. C. Werkman; Johanna H. M. Dri...; Coen D. A. Stehouwer; Peter Vestergaard; Nicolaas C. Schaper; Joop P. van den B...; Johannes T. H. Ni...
• Keywords: Sulfonylurea; Lower risk

Abstract Background Numerous studies have investigated the potential association of sodium-glucose co-transporter-2 inhibitors (SGLT2-Is) with an increased risk lower limb amputations (LLAs), but produced conflicting results. Particularly comparing SGLT2-Is to glucagon-like peptide-1 receptor agonists (GLP1-RAs) seem find a higher LLA SGLT2-I use. This raises question whether results are driven by protective GLP1-RA-effect rather than harmful SGLT2-I-effect. GLP1-RAs could promote wound healing and therefore reduce LLAs, associations between both drug classes remain uncertain. Therefore, aim current study was investigate diabetic foot ulcer (DFU) use GLP1-RA versus sulfonylurea Methods A retrospective population-based cohort conducted using data from Danish National Health Service (2013–2018). The population (N = 74,475) consisted type 2 diabetes patients aged 18 + who received first ever prescription SGLT2-I, or sulfonylurea. date defined start follow-up. Time-varying Cox proportional hazards models estimated hazard ratios (HRs) DFU SU were adjusted for age, sex, socio-economic variables, comorbidities concomitant Results Current not associated sulfonylureas {adjusted HR 1.10 [95% confidence interval (CI) 0.71–1.70]}. use, on other hand, [adjusted 0.57 (95%CI 0.39–0.84)] compared sulfonylureas. similar that exposures interest. Conclusion LLA, LLA. Previous reporting might been looking at effect, effect.