Introduction and Objective: This study examines the impact of Sodium-glucose cotransporter 2 inhibitors (SGLT2is) and metformin on severe Lower extremity arterial disease (LEAD) progression in elderly patients with type 2 diabetes (T2D). Using propensity score matching, a three-year analysis compares their distinct effects on risk using a real-world claims database.Methods: This retrospective cohort study analyzed insurance data for individuals aged 65 years, using health insurance claims and self-reported health checkup data from the web-based platform kencom by DeSC Healthcare Inc. Severe LEAD was defined as cases requiring revascularization after a LEAD diagnosis. After matching, hazard ratios (HR) for endpoints were analyzed using a Cox proportional hazards model.Results: After matching, baseline variables were similar. Incidence rates were 2.10 and 2.69 per 1,000 person-years for metformin and SGLT2is, respectively. Compared to metformin, SGLT2is showed a higher HR for severe LEAD, especially with diastolic blood pressure (dBP) below 80 mmHg (HR: 1.53) and eGFR between 30-60mL/min/1.73m2 (HR:2.32).Conclusion: The endothelial benefits of metformin, achieved without affecting hemodynamics, may be particularly effective in patients with low dBP or impaired renal function. In elderly patients with T2D, the presence of cardio vascular disease may often lead to the selection of SGLT2is. However, considering the status of LEAD, prioritizing the use of metformin may also be a prudent consideration.
T. Horii: None. Y. Oikawa: None. A. Shimada: Speaker’s Bureau; Sanofi. K. Mihara: None.
Source link
Leave a Reply