Newer glucose-lowering drugs best sulfonylureas, glinides in second-line treatment of T2D

Glucose-lowering drugs such as the glucagon-like peptide-1 receptor agonist (GLP-1-RA), sodium-glucose cotransporter 2 inhibitor (SGLT2i), and dipeptidyl peptidase-4 inhibitor (DPP-4i) work better and are more cost-effective than sulfonylureas and glinides (SU) as second-line treatment for type 2 diabetes (T2D), according to a population-based retrospective cohort study.

Researchers used linked regional healthcare utilization databases and identified residents in Lombardy, Italy, who were at least 40 years of age, treated with metformin in 2014, and initiated second-line treatment between 2015 and 2018 with SU, GLP-1-RA, SGLT2i, or DPP-4i. For each person who started SU, an individual who began other second-line treatments was randomly selected and matched according to sex, age, Multisource Comorbidity Score, and previous duration of metformin treatment.

The analysis included 22,867 participants with T2D, of whom 10,577 initiated SU, 8,125 initiated DPP-4i, 2,893 initiated SGLT2i, and 1,272 initiated GLP-1-RA in the second-line setting.

Compared with SU, newer glucose lowering drugs were associated with a substantial reduction in the risk of hospitalization for major adverse cardiovascular events (MACE) (DPP-4i: 22 percent, 95 percent confidence interval [CI], 3–37; SGLT2i: 29 percent, 95 percent CI, 12–44; GLP-1-RA: 41 percent, 95 percent CI, 26–53).

The incremental cost-effectiveness ratio values indicated an average savings of EUR 96.2 and EUR 75.7 each month free from MACE for patients on DPP-4i and SGLT2i, respectively.