Introduction & Objective: Patients with type 2 diabetes (T2D) are at increased risk of heart failure (HF). There is limited guidance on which diabetes medications clinicians should use in patients without established cardiovascular disease (CVD) to address this risk.
Methods: Using Medicare and 2 U.S. private health plans (2013-2023), we identified six pairwise cohorts of 1:1 propensity score-matched patients aged ≥18 years (≥66 years in Medicare) with T2D without established CVD (atherosclerotic CVD or HF) who initiated SGLT2i, GLP-1RA, DPP-4i, or SU (Table), and estimated HRs and 95% CIs for the risk of hospitalization for HF [using 2 definitions based on a HF discharge diagnosis in the primary position (HHF-primary), or in any position (HHF-any)] and a composite of HHF or mortality, adjusting for 156 covariatesResults: Over a mean follow-up of ~11 months, the risk of HHF (either definition) was lower among SGLT2i initiators compared to all other classes (risk reduction 16-56%). Compared to DPP4i or SU, initiators of GLP-1RA also had lower risk of HHF (risk reduction 27-40%) (Table). Results were consistent for the composite outcome, driven by a decreased risk of HHF.
Conclusion: This study suggests that in patients with T2D and without established CVD, initiation of SGLT2i or GLP-1RA is associated with lower risk of HHF compared to other diabetes medications.
H. Tesfaye: None. J.M. Paik: None. C. Alix: None. S. Cromer: Other Relationship; Johnson & Johnson Medical Devices Companies. Advisory Panel; Alexion Pharmaceuticals, Inc. Other Relationship; Wolters Kluwer Health. B.M. Everett: Consultant; Novo Nordisk. Research Support; Novo Nordisk. Consultant; Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Ipsen Pharmaceuticals, Provention Bio, Inc. R. Glynn: Research Support; Amarin Corporation, Kowa Pharmaceuticals America, Inc., Novartis AG, Pfizer Inc. D.J. Wexler: Other Relationship; Novo Nordisk. E. Patorno: Research Support; Boehringer-Ingelheim, Food and Drug Administration (FDA), National Institutes of Health, Patient-Centered Outcomes Research Institute.
PCORI
