Article Figures & Data
Tables
- Table 1.
Selected characteristics of older adults in Ontario, Canada, upon initiation of a sodium-glucose cotransporter-2 inhibitor or dipeptidyl peptidase-4 inhibitor
Baseline Characteristics Unweighted, n=144,694 Weighted, n=76,443 Dipeptidyl Peptidase-4 Users, n=105,700 Sodium-Glucose Cotransporter-2 Inhibitor Users, n=38,994 Standardized Difference Dipeptidyl Peptidase-4 Users, n=37,449 Sodium-Glucose Cotransporter-2 Inhibitor Users, n=38,994 Standardized Difference Demographics Age, mean, yr (SD) 74 (7) 72 (5) 0.38 72 (3) 72 (5) 0.00 Women, no. (%) 49,289 (47) 15,457 (40) 0.14 15,258 (41) 15,457 (40) 0.02 Long-term care, no. (%) 3560 (3) 283 (1) 0.19 302 (1) 283 (1) 0.01 Prescriber specialty, no. (%) Cardiology 440 (0) 1580 (4) 0.25 636 (2) 1580 (4) 0.14 Endocrinology 8743 (8) 5480 (14) 0.18 5068 (14) 5480 (14) 0.02 General practitioner 85,858 (81) 26,190 (67) 0.32 26,398 (71) 26,190 (67) 0.07 Internal medicine 3579 (3) 2652 (7) 0.16 2421 (7) 2652 (7) 0.01 Nephrology 803 (1) 758 (2) 0.10 612 (2) 758 (2) 0.02 Other 6277 (6) 2334 (6) 0.00 2313 (6) 2334 (6) 0.01 Comorbidities, no.(%) Mean duration of diabetes, yr (SD) 11.5 (7.4) 12.4 (7.6) 0.11 12.2 (4.4) 12.4 (7.6) 0.03 Fragility fracture 4,012 (4) 1204 (3) 0.04 1197 (3) 1204 (3) 0.01 Previous fall 17,225 (16) 5572 (14) 0.06 5439 (15) 5572 (14) 0.01 Dementia 7636 (7) 1094 (3) 0.20 1111 (3) 1094 (3) 0.01 Rheumatoid arthritis 2398 (2) 848 (2) 0.01 815 (2) 848 (2) 0.00 Osteoporosis 7839 (7) 1969 (5) 0.10 1926 (5) 1969 (5) 0.00 Coronary artery disease 24,571 (23) 12,258 (31) 0.18 10,961 (29) 12,258 (31) 0.05 Diabetic retinopathy 750 (1) 338 (1) 0.02 314 (1) 338 (1) 0.01 Diabetic neuropathy 1431 (1) 604 (2) 0.01 577 (2) 604 (2) 0.00 Medication use, no. (%) Bisphosphonates 9199 (9) 1952 (5) 0.15 1939 (5) 1952 (5) 0.01 Denosumab 2053 (2) 486 (1) 0.06 479 (1) 486 (1) 0.01 Oral steroid 8038 (8) 2732 (7) 0.02 2641 (7) 2732 (7) 0.00 Diabetes and kidney function, no. (%) No. of diabetes medications 0 37,006 (35) 10,916 (28) 0.15 10,454 (28) 10,916 (28) 0.00 1 51,484 (49) 20,902 (54) 0.10 19,976 (53) 20,902 (54) 0.01 2+ 17,210 (16) 7176 (18) 0.06 7019 (19) 7176 (18) 0.01 Metformin 61,485 (58) 25,896 (66) 0.17 24,803 (66) 25,896 (66) 0.00 Mean hemoglobin A1C, % (SD) 8.1 (1.6) 8.0 (1.5) 0.03 8.1 (0.9) 8.0 (1.5) 0.02 Diabetes management 54,022 (51) 22,108 (57) 0.11 21,383 (57) 22,108 (57) 0.01 Mean no. of general practitioner visits (SD) 14.2 (19.2) 12.37 (15.0) 0.11 12.4 (8.2) 12.37 (14.96) 0.01 Mean no. of endocrinology visits (SD) 0.5 (2.0) 0.8 (2.2) 0.13 0.7 (1.2) 0.8 (2.2) 0.06 Mean eGFR, ml/min per 1.73 m2 (SD) 69 (19) 73 (17) 0.23 73 (10) 73 (17) 0.01 eGFR category, ml/min per 1.73 m2 ≥90 14,853 (14) 6485 (17) 0.07 6319 (17) 6485 (17) 0.01 60 to <90 55,500 (53) 23,520 (60) 0.16 22,547 (60) 23,520 (60) 0.00 45 to <60 20,617 (20) 6577 (17) 0.07 6250 (17) 6577 (17) 0.01 30 to <45 14,730 (14) 2412 (6) 0.26 2332 (6) 2412 (6) 0.00 eGFR is measured in milliliters per minute per 1.73 m2. The most recent eGFR measurement in the 365-day period was before the cohort entry date (including the cohort entry date). eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation: 141×min([serum creatinine concentration in micromoles per liter per 88.4]/ĸ, 1)α×max([serum creatinine concentration in micromoles per liter per 88.4]/ĸ, 1)−1.209×0.993Age×1.018 [if a woman]. ĸ=0.7 if a woman and 0.9 if a man; α=−0.329 if a woman and −0.411 if a man. Min is the minimum of serum creatinine concentration/ĸ or one; max is the maximum of serum creatinine concentration/ĸ or one. On the basis of recent Ontario Renal Network guidelines, race was not factored into the calculation of eGFR.
- Table 2.
Prescription characteristics of sodium-glucose cotransporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors
Medication Mean Continuous Use, d (SD) Median Continuous Use, d (Interquartile Range) SGLT2i All, n=38,994 428 (414) 287 (89–645) Empagliflozin, n=22,095 379 (342) 283 (85–566) Canagliflozin, n=11,939 464 (477) 272 (78–711) Dapagliflozin, n=4960 414 (368) 291 (91–664) DPP-4i All, n=105,700 501 (454) 348 (135–778) Sitagliptin, n=78,633 480 (443) 329 (125–733) Linagliptin, n=22,415 504 (452) 358 (125–794) Saxagliptin, n=4652 470 (462) 283 (104–723) SGLT2i, sodium-glucose cotransporter-2 inhibitor; DPP-4i, dipeptidyl peptidase-4 inhibitor.
- Table 3.
Primary and secondary outcomes in the sodium-glucose cotransporter-2 inhibitor or dipeptidyl peptidase-4 inhibitor cohorts
Outcome at 180 d Dipeptidyl Peptidase-4, n=37,449, n (%) Sodium-Glucose Cotransporter-2 Inhibitor, n=38,994, n (%) Weighted Hazard Ratio (95% Confidence Interval) All fracture 172 (0.5) 170 (0.4) 0.95 (0.79 to 1.13) Falls 880 (2.4) 897 (2.3) 0.98 (0.91 to 1.05) Hypotension 40 (0.1) 41 (0.1) 0.98 (0.65 to 1.47) Hypoglycemia 81 (0.2) 77 (0.2) 0.91 (0.68 to 1.22) eGFR Group, ml/min per 1.73 m2 and Medication Fracture at 180 d, N (%) Weighted Hazard Ratio (95% Confidence Interval) P Value for Subgroup Interaction Fracture at 365 d, N (%) Weighted Hazard Ratio (95% Confidence Interval) P Value for Subgroup Interaction All DPP-4i, n=37,449 172 (0.46) 0.95 (0.79 to 1.13) N/A 360 (0.96) 0.88 (0.77 to 1.00) N/A SGLT2i, n=38,994 170 (0.44) 329 (0.84) eGFR ≥90 DPP-4i, n=6330 28 (0.45) 0.79 (0.46 to 1.38) 0.37 61 (0.96) 0.90 (0.63 to 1.28) 0.53 SGLT2I, n=6485 23 (0.35) 56 (0.86) eGFR 60 to <90 DPP-4i, n=22,625 95 (0.42) 1.10 (0.81 to 1.36) 194 (0.86) 0.94 (0.78 to 1.13) SGLT2i, n=23,520 104 (0.44) 189 (0.80) eGFR 45 to <60 DPP-4i, n=6198 28 (0.46) 1.00 (0.70 to 1.50) 68 (1.10) 0.82 (0.61 to 1.10) SGLT2i, n=6577 31 (0.47) 59 (0.90) eGFR 30 to <45 DPP-4i, n=2206 19 (0.88) 0.56 (0.30 to 1.06) 36 (1.64) 0.64 (0.43 to 0.95) SGLT2i, n=2412 12 (0.50) 25 (1.04) DPP-4i, dipeptidyl peptidase-4 inhibitor; SGLT2i, sodium-glucose cotransporter-2 inhibitor, eGFR, estimated glomerular filtration rate.
Supplemental Data