Related Experiment Video
Updated: Jul 1, 2025
28:13
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
33.4K
SGLT2 Inhibitors vs GLP-1 Receptor Agonists and Clinical Outcomes in Patients With Diabetes With/Without Atrial
Yi-Hsin Chan1,2,3,4, Tze-Fan Chao5,6, Shao-Wei Chen2,7
1The Cardiovascular Department, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan.
The Journal of Clinical Endocrinology and Metabolism
|March 11, 2024
Summary
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) may reduce heart failure hospitalizations in patients with type 2 diabetes and atrial fibrillation (AF). Further research is needed to confirm SGLT2i as a preferred treatment for this high-risk group.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Diabetes mellitus and atrial fibrillation (AF) commonly coexist, increasing cardiovascular risks.
- Understanding comparative drug outcomes in this population is crucial for effective management.
Purpose of the Study:
- To compare the outcomes of sodium-glucose cotransporter-2 inhibitors (SGLT2i) versus glucagon-like peptide-1 receptor agonists (GLP-1RAs) in patients with type 2 diabetes (T2D) with or without AF.
- To assess risks of hospitalization for heart failure (HF), composite kidney outcomes, major adverse cardiovascular events, and all-cause mortality.
Main Methods:
- Nationwide retrospective cohort study using the Taiwan National Health Insurance Research Database (May 2016 - December 2020).
- Included patients with T2D treated with SGLT2i or GLP-1RA, with or without AF.
- Propensity score-stabilized weighting was used to balance covariates between treatment groups.
Main Results:
- Patients with AF had higher incidence rates of all study outcomes compared to those without AF.
- In the AF cohort, SGLT2i use was associated with significantly lower risk of HF hospitalization (HR 0.48) and composite kidney outcomes (HR 0.47) compared to GLP-1RA.
- No significant differences in major adverse cardiovascular events or all-cause mortality were observed between SGLT2i and GLP-1RA in either cohort.
Conclusions:
- SGLT2i demonstrated a potential benefit in reducing HF hospitalizations and kidney outcomes in T2D patients with AF.
- The findings suggest SGLT2i may be a favorable option for T2D patients with concomitant AF, particularly those at high risk for HF.
- Further investigation is warranted to establish SGLT2i as a preferred therapy for this specific patient population.
Related Concept Videos
01:23Dipeptidyl Peptidase 4 Inhibitors
186
Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
186
01:19Oral Hypoglycemic Agents: α-Glucosidase Inhibitors
175
α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
Acarbose and miglitol are...
Acarbose and miglitol are...
175
01:06Oral Hypoglycemic Agents: Glinides
154
Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
154
01:24Glucagon-like Receptor Agonists
321
Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
321
01:26Oral Hypoglycemic Agents: Biguanides and Glitazones
199
Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
199
01:17Oral Hypoglycemic Agents: Sulfonylureas
208
Sulfonylureas are oral hypoglycemic agents utilized in treating type 2 diabetes. They are characterized by their unique sulfonylurea chemical structure. The family of sulfonylureas is divided into generations. First-generation sulfonylureas, including tolbutamide (Orinase), chlorpropamide (Diabinese), and tolazamide (Tolinase), trigger insulin release from pancreatic β cells and enhance peripheral tissues' insulin sensitivity. The second-generation members, such as glipizide...
208