Introduction & Objective: SGLT2i are recommended for the treatment of heart failure due to their cardioprotective effects, despite primarily being used as antidiabetic medications. However, the comparative profile of SGLT2i with DPP4i remains unclear. This study aims to compare the efficacy and safety of SGLT2is versus DPP4is as initial therapy in older adults with type 2 diabetes.

Methods: A comprehensive search was conducted in PubMed, EMBASE, ScienceDirect, Google Scholar, and Cochrane Central using appropriate Mesh terms from inception until February 23, 2023. The outcomes were pooled using a random-effects model for Hazard ratio (HR) with a 95% confidence interval. A p-value of <0.05 was considered statistically significant.

Results: 12 studies were included after systematic screening, with a sample size of 745,688 for SGLT2is and 769,386 for DPP4is. The mean age in each group was 61.1 (8.52) and 61.28 (9.25) years, respectively. Upon pooling the included articles with SGLT2i versus DPP4i, the primary outcome of all-cause death demonstrated an HR of 0.64 [0.57, 0.70], I2: 65.54%, p<0.001, and major adverse cardiovascular events (MACE) yielded an HR of 0.76 [0.65, 0.86], I2: 87.83%, p<0.001. The secondary outcomes included myocardial infarction with an HR of 0.84 [0.78, 0.90], I2: 47.64%, p<0.001, stroke with an HR of 0.81 [0.75, 0.87], I2: 36.78%, p<0.001, and Hospitalization with an HR of 0.62 [0.53, 0.70], I2: 83.32%, p<0.001.

Conclusion: Our findings suggest that compared to DPP4is, initiating treatment with SGLT2is provides cardiovascular disease protection and can be considered for use in patients with type 2 diabetes.

Disclosure

A.B. Shrestha: None. K. Rajak: None. N. Tummala: None. G. Maddineni: None.

© 2024 by the American Diabetes Association
2024
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