Sodium-Glucose Cotransporter 2 Inhibitors vs Incretin-Based Drugs and Risk of Fractures for Type 2 Diabetes

JAMA Netw OpenPublished Retrospective cohort study

Authors' conclusion

This population-based cohort study suggests that SGLT2i was not associated with an increased rate of incident fractures compared with DPP4i and GLP1RA, separately, among postmenopausal individuals with type 2 diabetes.

Study context

Population
Postmenopausal individuals (aged ≥45 years) with type 2 diabetes, nationwide claims data of Korea, 2013–2020two separate comparison cohorts
Exposure
SGLT2i vs DPP4i and vs GLP1RA, separately
  • DPP4in = 332,004reference
  • GLP1RAn = 8,177reference
Outcome
Overall fractures (vertebral, hip, humerus and distal radius)
Methodological detailsactive-comparator, new-user, nationwide claims data, propensity score fine stratification, weighted Cox models
  • Active-comparator
  • New-user
  • Nationwide claims data
  • Propensity score fine stratification
  • Weighted Cox models

Main finding

As reported in the abstract

Overall fractures
Weighted hazard ratio (95% CI)
SGLT2i vs DPP4i37 530 SGLT2ivs 332 004 DPP4i new users
0.78(0.72–0.84)
SGLT2i vs GLP1RA111 835 SGLT2ivs 8177 GLP1RA new users
0.92(0.68–1.24)

Observational data: associations, not effects.

Further findings

Subgroup and sensitivity analyses

Consistent results with main analysis

Original publication

Sodium-Glucose Cotransporter 2 Inhibitors vs Incretin-Based Drugs and Risk of Fractures for Type 2 Diabetes. JAMA Netw Open. Published 5 September 2023. doi:10.1001/jamanetworkopen.2023.35797

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