The association between sodium glucose cotransporter‐2 inhibitors vs dipeptidyl peptidase‐4 inhibitors and renal outcomes in people discharged from hospital with type 2 diabetes: A population‐based cohort study

Background We investigated the association between post‐hospital discharge use of sodium glucose cotransporter‐2 inhibitors (SGLT‐2is) compared to dipeptidyl peptidase‐4 inhibitors (DPP‐4is) and the incidence of hospitalization for acute renal failure (ARF) and chronic kidney disease (CKD) in people with type 2 diabetes. Methods We conducted a retrospective cohort study using linked hospital and prescription data. Our cohort included people aged ≥30 years with type 2 diabetes discharged from a hospital in Victoria, Australia, from December 2013 to June 2018. We compared new users of SGLT‐2is with new users of DPP‐4is following discharge. People were followed from first dispensing of a SGLT‐2i or DPP‐4i to a subsequent hospital admission for ARF or CKD. We used competing risk models with inverse probability of treatment weighting (IPTW) to estimate subhazard ratios. Results In total, 9620 people initiated SGLT‐2is and 9962 initiated DPP‐4is. The incidence rate of ARF was 12.3 per 1000 person‐years (median years of follow‐up [interquartile range [IQR] 1.4 [0.7–2.2]) among SGLT‐2i initiators and 18.9 per 1000 person‐years (median years of follow‐up [IQR] 1.7 [0.8–2.6]) among DPP‐4i initiators (adjusted subhazard ratio with IPTW 0.78; 95% confidence interval [CI] 0.70–0.86). The incidence rate of CKD was 6.0 per 1000 person‐years (median years of follow‐up [IQR] 1.4 [0.7–2.2]) among SGLT‐2i initiators and 8.9 per 1000 person‐years (median years of follow‐up [IQR] 1.7 [0.8–2.6]) among DPP‐4i initiators (adjusted subhazard ratio with IPTW 0.83; 95% CI 0.73–0.94). Conclusions Real‐world data support using SGLT‐2is over DPP‐4is for preventing acute and chronic renal events in people with type 2 diabetes. Highlights What are the new findings? This was the first Australian study using real‐world data to show SGLT‐2is reduce ARF and CKD compared to DPP‐4is in people with type 2 diabetes. The rates of hospital admissions for ARF and CKD in people with type 2 diabetes were 22% and 17% lower, respectively, among SGLT‐2i initiators compared to DPP‐4i initiators. How might this have an impact on clinical practice in the foreseeable future? Our study suggests that benefits of SGLT‐2is apparent in clinical trials, in preventing acute and chronic renal events in people with type 2 diabetes, are reflected in real‐world clinical practice.