scholarly journals Comparative Effectiveness of SGLT2 Inhibitors, GLP-1 Receptor Agonists, DPP-4 Inhibitors, and Sulfonylureas on Risk of Kidney Outcomes: Emulation of a Target Trial Using Health Care Databases

Diabetes Care ◽  
2020 ◽  
Vol 43 (11) ◽  
pp. 2859-2869 ◽  
Author(s):  
Yan Xie ◽  
Benjamin Bowe ◽  
Andrew K. Gibson ◽  
Janet B. McGill ◽  
Geetha Maddukuri ◽  
...  
Keyword(s):  
Health Care ◽  
Comparative Effectiveness ◽  
Sglt2 Inhibitors ◽  
Target Trial ◽  
Receptor Agonists

scholarly journals Comparative Effectiveness and Safety of Sodium–Glucose Cotransporter 2 Inhibitors Versus Glucagon-Like Peptide 1 Receptor Agonists in Older Adults

2021 ◽  
Author(s):  
Elisabetta Patorno ◽  
Ajinkya Pawar ◽  
Lily G. Bessette ◽  
Dae H. Kim ◽  
Chintan Dave ◽  
...  
Keyword(s):  
Older Adults ◽  
Comparative Effectiveness ◽  
Kidney Injury ◽  
Cardiovascular Death ◽  
Sglt2 Inhibitors ◽  
Major Adverse Cardiovascular Events ◽  
Receptor Agonists ◽  
Increased Risk ◽  
Glucagon Like Peptide 1 ◽  
Tract Infections

<b>Objective</b>: Both SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1RA) demonstrated cardiovascular benefits in RCTs of patients with type 2 diabetes (T2D) generally <65 years and mostly with cardiovascular disease (CVD). We aimed to evaluate the comparative effectiveness and safety of SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1RA) among real-world older adults. <p><b>Methods</b>: Using Medicare data (4/2013-12/2016), we identified 90,094 1:1 propensity score-matched T2D patients ≥66 years initiating SGLT2i or GLP-1RA. Primary outcomes were major adverse cardiovascular events (MACE, i.e., myocardial infarction, stroke or cardiovascular death) and hospitalization for heart failure (HHF). Other outcomes included diabetic ketoacidosis (DKA), genital infections (GI), fractures, lower-limb amputations (LLA), acute kidney injury (AKI), severe urinary tract infections (UTI), and overall mortality. We estimated hazard ratios (HR) and rate differences (RD) per 1000 person-years, controlling for 140 baseline covariates. </p> <p><a><b>Results</b></a>: Compared with GLP-1RA, SGLT2i initiators had similar MACE risk [HR (95% CI)=0.98 (0.87-1.10); RD (95% CI)= -0.38 (-2.48,1.72)] and reduced HHF risk [HR=0.68 (0.57-0.80)]; RD= -3.23 (-4.68,-1.77)], over a median follow up of approximately 6 months. They also had 0.7 [RD=0.72 (0.02, 1.41)] more DKA, 0.9 [RD=0.90 (0.10, 1.70)] more LLA, 57.1 [RD=57.08 (53.45, 60.70)] more GI, and 7.1 [RD=-7.05 (-10.27, -3.83)] fewer AKI events. </p> <p><b>Conclusions</b>: Among older adults, SGLT2i had similar MACE risk, decreased HHF risk, and increased risk of DKA, LLA, and GI, vs. GLP-1RA. </p>

scholarly journals Comparative Effectiveness and Safety of Sodium–Glucose Cotransporter 2 Inhibitors Versus Glucagon-Like Peptide 1 Receptor Agonists in Older Adults

2021 ◽  
Author(s):  
Elisabetta Patorno ◽  
Ajinkya Pawar ◽  
Lily G. Bessette ◽  
Dae H. Kim ◽  
Chintan Dave ◽  
...  
Keyword(s):  
Older Adults ◽  
Comparative Effectiveness ◽  
Kidney Injury ◽  
Cardiovascular Death ◽  
Sglt2 Inhibitors ◽  
Major Adverse Cardiovascular Events ◽  
Receptor Agonists ◽  
Increased Risk ◽  
Glucagon Like Peptide 1 ◽  
Tract Infections

<b>Objective</b>: Both SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1RA) demonstrated cardiovascular benefits in RCTs of patients with type 2 diabetes (T2D) generally <65 years and mostly with cardiovascular disease (CVD). We aimed to evaluate the comparative effectiveness and safety of SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1RA) among real-world older adults. <p><b>Methods</b>: Using Medicare data (4/2013-12/2016), we identified 90,094 1:1 propensity score-matched T2D patients ≥66 years initiating SGLT2i or GLP-1RA. Primary outcomes were major adverse cardiovascular events (MACE, i.e., myocardial infarction, stroke or cardiovascular death) and hospitalization for heart failure (HHF). Other outcomes included diabetic ketoacidosis (DKA), genital infections (GI), fractures, lower-limb amputations (LLA), acute kidney injury (AKI), severe urinary tract infections (UTI), and overall mortality. We estimated hazard ratios (HR) and rate differences (RD) per 1000 person-years, controlling for 140 baseline covariates. </p> <p><a><b>Results</b></a>: Compared with GLP-1RA, SGLT2i initiators had similar MACE risk [HR (95% CI)=0.98 (0.87-1.10); RD (95% CI)= -0.38 (-2.48,1.72)] and reduced HHF risk [HR=0.68 (0.57-0.80)]; RD= -3.23 (-4.68,-1.77)], over a median follow up of approximately 6 months. They also had 0.7 [RD=0.72 (0.02, 1.41)] more DKA, 0.9 [RD=0.90 (0.10, 1.70)] more LLA, 57.1 [RD=57.08 (53.45, 60.70)] more GI, and 7.1 [RD=-7.05 (-10.27, -3.83)] fewer AKI events. </p> <p><b>Conclusions</b>: Among older adults, SGLT2i had similar MACE risk, decreased HHF risk, and increased risk of DKA, LLA, and GI, vs. GLP-1RA. </p>

A Standard Set of Outcome Measures for the Comprehensive Appraisal of Cleft Care

2017 ◽  
Vol 54 (5) ◽  
pp. 540-554 ◽  
Author(s):  
Alexander C. Allori ◽  
Thomas Kelley ◽  
John G. Meara ◽  
Asteria Albert ◽  
Krishnamurthy Bonanthaya ◽  
...  
Keyword(s):  
Health Care ◽  
Outcome Measures ◽  
Comparative Effectiveness ◽  
Cleft Lip ◽  
Effectiveness Research ◽  
Data Standards ◽  
Prospective Data ◽  
Treatment Protocols ◽  
Multidisciplinary Working ◽  
Standard Set

Care of the patient with cleft lip and/or palate remains complex. Prior attempts at aggregating data to study the effectiveness of specific interventions or overall treatment protocols have been hindered by a lack of data standards. There exists a critical need to better define the outcomes- particularly those that matter most to patients and their families-and to standardize the methods by which these outcomes will be measured. This report summarizes the recommendations of an international, multidisciplinary working group with regard to which outcomes a typical cleft team could track, how those outcomes could be measured and recorded, and what strategies may be employed to sustainably implement a system for prospective data collection. It is only by agreeing on a common, standard set of outcome measures for the comprehensive appraisal of cleft care that intercenter comparisons can become possible. This is important for quality-improvement endeavors, comparative effectiveness research, and value-based health-care reform.

SGLT2 inhibitors: A revolution in therapeutics of a major Non-Communicable Disease

2021 ◽  
pp. 1-3
Author(s):  
Muhammad Sami Khan
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Health Care Providers ◽  
Communicable Disease ◽  
Health Care Expenditure ◽  
Health Care Expenditures ◽  
Sglt2 Inhibitors ◽  
Care Providers ◽  
Cardiovascular Outcome Trials ◽  
Non Communicable Disease

Pakistan is facing an exorbitant burden of Non-communicable diseases among which Cardiovascular diseases are the most prominent which has not only caused mortality but also posed a big threat on weakened economy and health care system of the country. Amidst of this growing crisis, Sodium glucose co-transporter 2 (SGLT2) inhibitors emerge as a ray of hope by reducing simultaneously the complication and health care expenditure associated with the management of this major mortality-bringing Non-communicable disease. SGLT2 inhibitors, including Dapagliflozin and Empagliflozin, are evidence-based standardized novel anti-diabetic agents tested in cardiovascular outcome trials namely DAPA-HF and EMPEROR-Reduced, when added to standard care in heart failure patients with reduced ejection fraction, provides breakthrough heart failure outcomes and also addresses massive health care expenditures. This novel finding provides an impetus to promote its beneficial effects among health care providers and early implementation. Continuous....

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