200-LB: Benefit of Dual Therapy with GLP-1 RA and SGLT2i on Cardiovascular Outcomes in Type 2 Diabetes

Background: Evidence on the cardiovascular benefit of dual glucagon like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose co-transporter-2 inhibitor (SGLT2i) therapy is lacking. Aim: To compare the benefit of dual GLP-1 RA and SGLT2i therapy to other dual type 2 diabetes therapies with respect to heart failure and major cardiovascular adverse events (MACE). Methods: From 2010-2021 patients from the Danish nationwide registries were followed from start of dual second-line type 2 diabetes treatment. Primary outcome was heart failure, and secondary outcomes were MACE and all-cause death. The estimated risk following 1 of 4 dual therapy combinations was determined using a longitudinal causal inference framework assuming all patients followed one dual therapy for 5 years. Results: A total of 87,201 persons were included (GLP-1 RA and SGLT2i: 14,831, GLP-1 RA and DPP4/SU/TZD: 20,417, SGLT2i and DPP4/SU/TZD: 22,803, dual DPP4/SU/TZD: 29,150). The 5-year risk ratio (95% CI) of dual GLP-1 RA and SGLT2i therapy compared to reference (dual DPP4/SU/TZD) for heart failure was: 0.93 (0.87;1.00), for MACE: 0.91 (0.87;0.95) and for all cause death: 0.78 (0.74;0.82), see Figure. Conclusion: Dual therapy with GLP-1 RA and SGLT2i showed a benefit on heart failure compared to other dual therapies. Dual therapy with GLP-1 RA and SGLT2i showed a benefit on MACE and all-cause death compared to the reference treatment.