Diabetes research and clinical practice · 2026
Cardiorenal protective effects of anti-diabetic drugs in early stage Cardiovascular-Kidney-Metabolic Syndrome: A multicenter, time-varying analysis.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Hao Wen-Rui, Liu Ju-Chi, Fang Yu-Ann, Hsu Min-Huei, Hsiu Hsin, Chen Chun-Chao
Аннотация
OBJECTIVES: Cardiovascular-kidney-metabolic (CKM) syndrome links metabolic risk factors with cardiorenal complications. However, real-world comparisons of cardiorenal outcomes among different antidiabetic agents (ADAs) in early CKM stages remain limited.
STUDY DESIGN: We conducted a retrospective cohort study using the Taipei Medical University Clinical Research Database. Adults with newly diagnosed diabetes initiating ADAs between 2016 and 2019 were included. Time-varying Cox proportional hazards models were used to evaluate associations between eight ADA classes-sodium-glucose cotransporter-2 inhibitors (SGLT2i), metformin, sulfonylureas, thiazolidinediones, alpha-glucosidase inhibitors, meglitinides, DPP-4 inhibitors, and insulin-and risks of stroke, acute myocardial infarction (AMI), end-stage renal disease (ESRD), and all-cause mortality.
RESULTS: Among 18,467 patients (mean age 61 years), most ADAs were associated with reduced cardiovascular risk compared with non-use. Insulin therapy was associated with increased risks of stroke (adjusted hazard ratio [aHR] 1.65) and AMI (aHR 2.47). Compared with SGLT2i, other ADAs were associated with higher risks of ESRD (aHR 3.62-19.16) and all-cause mortality (aHR 5.80-66.84). The absence of SGLT2i therapy was associated with greater ESRD risk in younger and obese patients.
CONCLUSIONS: In early CKM, most ADAs reduce cardiovascular risk, but SGLT2 inhibitors provide superior renal protection and survival benefits.
STUDY DESIGN: We conducted a retrospective cohort study using the Taipei Medical University Clinical Research Database. Adults with newly diagnosed diabetes initiating ADAs between 2016 and 2019 were included. Time-varying Cox proportional hazards models were used to evaluate associations between eight ADA classes-sodium-glucose cotransporter-2 inhibitors (SGLT2i), metformin, sulfonylureas, thiazolidinediones, alpha-glucosidase inhibitors, meglitinides, DPP-4 inhibitors, and insulin-and risks of stroke, acute myocardial infarction (AMI), end-stage renal disease (ESRD), and all-cause mortality.
RESULTS: Among 18,467 patients (mean age 61 years), most ADAs were associated with reduced cardiovascular risk compared with non-use. Insulin therapy was associated with increased risks of stroke (adjusted hazard ratio [aHR] 1.65) and AMI (aHR 2.47). Compared with SGLT2i, other ADAs were associated with higher risks of ESRD (aHR 3.62-19.16) and all-cause mortality (aHR 5.80-66.84). The absence of SGLT2i therapy was associated with greater ESRD risk in younger and obese patients.
CONCLUSIONS: In early CKM, most ADAs reduce cardiovascular risk, but SGLT2 inhibitors provide superior renal protection and survival benefits.