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Use of Sodium-Glucose Co-Transporter-2-Inhibitors (SGLT2-Is) and Risk of Lower Limb Amputation

[ Vol. 16 , Issue. 1 ]

Author(s):

Nikki C.C. Werkman, Johannes T.H. Nielen, Joop P.W. van den Bergh , Niels Ejskjaer, Johan Røikjer, Nicolaas C. Schaper, Bernardette Rossi , Olaf Klungel, Peter Vestergaard, Frank de Vries* and Johanna H.M. Driessen   Pages 62 - 72 ( 11 )

Abstract:


Background: Treatment with sodium-glucose co-transporter-2-inhibitors (SGLT2-Is), such as canagliflozin, has been associated with an increased risk of lower limb amputations (LLAs) in type 2 diabetes mellitus (T2DM). However, conflicting results have been reported for different SGLT2-Is and the underlying mechanism is unclear.

Objective: To investigate the risk of LLA and diabetic foot ulcer with SGLT2-I use compared to other anti-diabetic drugs and to explore hypovolemia as a potential underlying mechanism.

Methods: A cohort study was conducted using data from the Clinical Practice Research Datalink GOLD (2013-2019). The study population (N=51,847) consisted of T2DM patients over 18 years of age with at least one prescription of a non-insulin anti-diabetic drug. Concomitant diuretic use and the presence of signs of hypovolemia were determined to assess the potential underlying mechanism. Cox proportional hazard models were used to estimate the hazard ratio (HR) for LLA in current SGLT2-I use versus current sulphonylurea (SU) use. Analyses were adjusted for lifestyle variables, comorbidities, and concomitant drug use.

Results: Current SGLT2-I use was not associated with an increased risk of LLA compared to current SU use (fully adjusted HR 0.70; 95% confidence interval 0.38-1.29). Concomitant use of diuretics and the presence of signs of hypovolemia were not associated with an increased risk of LLA.

Conclusion: Use of SGLT2-Is, with or without signs of hypovolemia, was not associated with an increased risk of LLA or DFU versus current SU use. Future studies powered to detect potential differences between individual SGLT2-Is are required to rule out a canagliflozin-specific effect.

Keywords:

SGLT2 inhibitors, Type 2 diabetes mellitus, Amputation, Hypovolemia, Cohort study, CPRD.

Affiliation:

Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Department of Clinical Medicine, Aalborg University, Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Directorate Pharmaceutical Affairs, Department for Policy in Health, Ministry for Health, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, Department of Clinical Medicine, Aalborg University, Aalborg, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht



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