Neel Deshpande, Internal Medicine
The article “Comparing Effectiveness and Safety of SGLT2 Inhibitors vs DPP-4 Inhibitors in Patients” by Elvira D’Andrea et al. analyzes the effects of two common Type 2 Diabetes prescriptions: SGLT2 and DPP-4. Glucose is an essential molecule found in carbohydrates that, with the help of insulin, can enter and fuel the various cells in your body. However, the human body is not perfect and complications can arise causing Type 2 Diabetes, a condition where the body either does not produce enough insulin, or the body cells become insulin resistant. To combat this, two uniquely functioning inhibitors are used to lower blood sugar: SGLT2 and DPP-4 inhibitors. The main difference between them is that SGLT2 inhibitors block glucose in the kidneys from being reabsorbed into the bloodstream, while DPP-4 inhibitors stimulate insulin secretion by breaking down incretin hormones which are released into the bloodstream to regulate insulin levels.
The researchers analyzed health records of 32,000 patients with Type 2 Diabetes and discovered that SGLT2 inhibitors were more effective than DPP-4 inhibitors for patients with baseline HbA1c (a test to measure the average blood sugar across 3 months) levels above eight percent. However, for patients with HbA1c levels below eight percent, the difference between the two was not significant. Another crucial observation between SGLT2 and DPP-4 inhibitors was that patients taking SGLT2 inhibitors were more susceptible to genital and urinary tract infections but had a lower risk of hypoglycemia. This information can inform physicians' decisions on selecting the most appropriate treatment option for their patients. For example, physicians may consider using SGLT2 inhibitors as a first-line treatment for patients with Type 2 Diabetes who have high HbA1c levels or a history of cardiovascular disease.
References
D’Andrea E, Wexler DJ, Kim SC, Paik JM, Alt E, Patorno E. Comparing Effectiveness and Safety of SGLT2 Inhibitors vs DPP-4 Inhibitors in Patients With Type 2 Diabetes and Varying Baseline HbA1c Levels. JAMA Intern Med. 2023;183(3):242–254. doi:10.1001/jamainternmed.2022.6664
Comments