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Effect of SGLT2 Inhibitors on Diabetes Progression in Statin-Treated Patients: A Population-Based Cohort Study

Jack Ssu-Chi Cheng1,2, Fang-Ju Lin1,3,4, Chih-Min Fu3

  • 1Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.

Clinical Epidemiology
|April 28, 2025
PubMed
Abstract

Insights

Sodium-glucose co-transporter 2 inhibitors (SGLT2is) significantly reduced diabetes progression in patients taking statins compared to sulfonylureas/meglitinides. This suggests SGLT2is may mitigate statin-related metabolic effects and slow disease advancement.

Area of Science:

  • Endocrinology
  • Pharmacology
  • Metabolic Diseases

Background:

  • Statins, commonly prescribed medications, are associated with accelerated diabetes progression.
  • There is a clinical need for interventions to counteract the adverse metabolic effects of statins in diabetic patients.

Purpose of the Study:

  • To compare the efficacy of sodium-glucose co-transporter 2 inhibitors (SGLT2is) versus sulfonylureas or meglitinides in managing diabetes progression among patients concurrently using statins.
  • To evaluate the impact of different second-line antidiabetic agents on key markers of diabetes advancement.

Main Methods:

  • A retrospective cohort study using Taiwan's National Health Insurance Research Database (2016-2020).
  • Inclusion criteria: patients with diabetes on statins, newly initiated on SGLT2is or sulfonylureas/meglitinides.
  • Diabetes progression defined by insulin initiation, medication class escalation, or acute hyperglycemic events; propensity score matching and Cox regression were employed.

Main Results:

  • SGLT2i users demonstrated a significantly lower risk of overall diabetes progression (HR: 0.53) compared to sulfonylurea/meglitinide users.
  • SGLT2is were associated with reduced insulin initiation (HR: 0.48) and medication class escalation (HR: 0.53).
  • No significant difference was observed in the risk of acute glycemic complications between the two groups (HR: 2.47).

Conclusions:

  • Sodium-glucose co-transporter 2 inhibitors (SGLT2is) show promise as an effective second-line therapy for diabetic patients on statins, potentially slowing disease progression.
  • SGLT2is may help mitigate statin-induced metabolic disturbances, warranting further investigation.
  • Randomized controlled trials and studies with detailed laboratory data are recommended to validate these findings.
Keywords:
SGLT2isdiabetes mellitusstatin-associated diabetes progressionstatins

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