In Diabetes Care, 2 studies report associations of sodium–glucose cotransporter 2 inhibitor (SGLT2i) use with lower risks of atrial fibrillation (AF) and dementia. A third study identified potential reductions in microvascular complications when individuals with type 2 diabetes have higher vitamin D levels.
Compared with glucagon-like peptide 1 (GLP-1) receptor agonists, new SGLT2i use was associated with a modestly reduced risk of new-onset AF, report authors of an analysis based on registry data from Denmark, Norway, and Sweden. “The adjusted incidence rate of new-onset AF was 8.6 per 1,000 person-years for new users of SGLT2 inhibitors compared with 10.0 per 1,000 person-years for new users of GLP-1 receptor agonists,” the researchers report. “The adjusted hazard ratio (aHR) was 0.89 (95% CI 0.81–0.96), and the rate difference was 1.4 fewer events per 1,000 person-years (95% CI 0.6–2.1).…”
Older people (age ≥66 years) in Ontario with type 2 diabetes had a lower risk of dementia when they used SGLT2i therapy as opposed to dipeptidyl peptidase 4 (DPP-4) inhibitors, according to a second study: “Among 106,903 individuals, SGLT2 inhibitors compared with DPP-4 inhibitors were associated with lower risk of dementia (14.2/1,000 person-years; aHR 0.80 [95% CI 0.71–0.89]) over a mean follow-up of 2.80 years from cohort entry. When stratified by different SGLT2 inhibitors, dapagliflozin exhibited the lowest risk (aHR 0.67 [95% CI 0.53–0.84]), followed by empagliflozin (aHR 0.78 [95% CI 0.69–0.89]), whereas canagliflozin showed no association (aHR 0.96 [95% CI 0.80–1.16]). The as-treated analysis observed a larger association (aHR 0.66 [95% CI 0.57–0.76]) than the intention-to-treat analysis.…”
Higher serum concentrations of serum 25-hydroxyvitamin D [25(OH)D] “were significantly associated with lower risk of diabetic microvascular complications, including diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy,” report authors of the third study. Data from the U.K. Biobank for people with type 2 diabetes showed these benefits of elevated vitamin D levels: “Compared with participants with 25(OH)D <25 nmol/L, individuals with 25(OH)D ≥75 nmol/L had a multivariable-adjusted HR of 0.65 (95% CI 0.51, 0.84) for composite diabetic microvascular complications, 0.62 (0.40, 0.95) for diabetic retinopathy, 0.56 (0.40, 0.79) for diabetic nephropathy, and 0.48 (0.26, 0.89) for diabetic neuropathy.”