Comparing the effectiveness of sodium-glucose co-transporter 2 inhibitors in patients with type 2 diabetes, congestive heart failure, or chronic kidney disease
Introduction: Sodium glucose co-transporter 2 (SGLT2) inhibitors are first-line treatment for type 2 diabetes, congestive heart failure, or chronic kidney disease as they have been proven to lower the cardiovascular risk for patients with these diseases. However, the cardioprotective benefits of individual SGLT2 inhibitors have yet to be compared with each other.
Aim: The aim is to perform head-to-head comparisons of the cardiovascular effects of individual SGLT2 inhibitors in patients with type 2 diabetes (Study 1), congestive heart failure (Study 2), or chronic kidney disease (Study 3) with the goal of determining the most effective SGLT2 inhibitor for each disease.
Methods: I will conduct three population-based cohort studies of all Danes ≥18 years of age with type 2 diabetes, congestive heart failure, or chronic kidney disease initiating SGLT2 inhibitor treatment during 1995–2021. These patients will be identified from nationwide Danish registries on hospital diagnoses, filled drug prescriptions, and laboratory results. I will follow patients from initiation of SGLT2 treatment until first occurrence of congestive heart failure, all-cause death, emigration, or December 31, 2021. I will use a target trial emulation design to mimic the eligibility criteria, washout period, treatment groups, and follow-up periods of randomized clinical trials using observational data. I will use pooled logistic regression to estimate the association between SGLT2 inhibitor treatment and congestive heart failure and/or all-cause death. Confounding will be addressed through inverse probability of treatment weighting.
Perspective: The results of this research will have significant implications for healthcare providers and decision-makers, as it will provide crucial insights for the development of evidence-based treatment guidelines for type 2 diabetes, congestive heart failure, and chronic kidney disease. Furthermore, through the use of target trial emulation, this project will serve as a trailblazer, demonstrating the efficiency and applicability of this design in comparing multiple treatments, and thus advancing future pharmacoepidemiological research in the field of cardiovascular medicine.
Morten Schmidt, Aarhus University, Dept. of Clinical Epidemiology, and Dept. of Cardiology, Aarhus University Hospital