Sodium–glucose cotransporter 2 inhibitors compared with other glucose-lowering drugs in Japan: Subanalyses of the CVD-REAL 2 Study

There are limited data on cardiovascular efficacy and safety of type 2 diabetes therapies in Japan, where treatments are characterized by lower metformin use and higher dipeptidyl peptidase-4 inhibitor (DPP4i) use versus other countries. We investigated the cardiovascular outcomes in Japanese patients with type 2 diabetes initiating sodium–glucose cotransporter 2 inhibitors (SGLT2i) matched 1:1 to patients initiating other glucose-lowering drugs (33,890 patients/group) or DPP4i (9,876 patients/group). SGLT2i initiation was associated with lower risks (hazard ratio of in-hospital death [death] 0.56, 95% confidence interval [CI] 0.47–0.67; hospitalization for heart failure 0.75, 95% CI 0.64–0.89; composite of hospitalization for heart failure or death 0.65, 95% CI 0.58–0.74 and stroke 0.66, 95% CI 0.52–0.84 versus other glucose-lowering drugs and lower risks of death 0.52, 95% CI 0.36–0.73) and composite of hospitalization for heart failure or death (0.65, 95% CI 0.51–0.83) versus DPP4i. In conclusion, SGLT2i initiators had lower risks of cardiovascular events versus other glucose-lowering drug initiators and, uniquely, versus DPP4i initiators in Japanese real-world practice.