Efficacy,Cardiovascular Benefits And Safety Of Anti-Diabetic Drugs Among Patients With Type 2 Diabetes

Objective:Metformin is commonly used as first line therapy combined with lifestyle intervention in patients with type 2 diabetes.However,many patients started a second medication due to unsatisfied glycemic control within one year.Practitioners and patients especially focused on the cardio-protective effect of these medications.This study aimed to investigate the cardio-protective effect of anti-diabetic drugs.Methods:This was a retrospective cohort study with about ten thousand patients with type 2 diabetes from 2010 to 2020 at baseline.Propensity score matching was used to balance the baseline characteristics and all patients were further divided into four groups(glimepiride,sitagliptin,dapagliflozin and liraglutide).Each group had 500 patients.The primary outcomes were differences in cardio-metabolic metrics after three months and six months of follow-up,as well as the major adverse cardiovascular events and severe hypoglycemia events.Results:No difference was shown in hemoglobin Alc,body mass index,systolic blood pressure and lipid profiles at baseline for all four groups.At three months,hemoglobin Alc showed significant reduction in all four groups.Patients in both dapagliflozin and liraglutide groups showed reduction in body mass index(2kg/m2 and 1.8kg/m2 respectively,P<0.05),systolic blood pressure(3mmHg and 7mmHg respectively,P<0.05)and lipid profiles(lower triglyceride and low density lipoprotein levels)beyond hemoglobin Alc,while patients in glimepiride and sitagliptin group showed no benefit in cardio-metabolic metrics.At six months,patients in dapagliflozin and liraglutide groups continued to show reduction in cardio-metabolic metrics while no difference was shown in patients in the glimepiride and sitagliptin group.The major adverse cardiovascular events were reduced by 14%(hazard ratio 0.86,95%CI 0.78-0.94)and 21%(hazard ratio 0.79,95%CI 0.74-0.84)in liraglutide and dapagliflozin groups respectively.There were total 10 severe hypoglycemia events in glimepiride group,3 in sitagliptin group,2 in liraglutide group and 1 in dapagliflozin group occurred during the observational period.Conclusion:Among the four second-line anti-diabetic drugs,dapagliflozin and liraglutide showed significant benefits on patients beyond glycemic control.This study based on real world evidence showed that both dapagliflozin and liraglutide have cardioprotective effect.For safety,glimepiride can cause severe hypoglycemia events while other drugs have similar effects of risks on hypoglycemia.