Danish target trial emulation finds modest neuropathy benefit emerging following year 3, but high discontinuation rates complicate causal interpretation
Clinical Report: SGLT-2is Edge GLP-1 RAs on Foot Disease
Overview
Revise to emphasize the clinical significance of the 1% difference in foot disease risk.
Background
Diabetic foot disease is a significant complication of type 2 diabetes, leading to increased morbidity and healthcare costs. Understanding the comparative risks associated with different diabetes medications is crucial for optimizing patient outcomes. This study provides insights into the long-term risks of foot disease associated with SGLT-2 inhibitors and GLP-1 receptor agonists.
Data Highlights
Medication
6-Year Risk of Diabetic Foot Disease
Risk Ratio
SGLT-2 Inhibitors
11%
0.90
GLP-1 Receptor Agonists
12%
-
Key Findings
SGLT-2i users had a 6-year risk of peripheral neuropathy of 4% compared to 5% for GLP-1 RA users.
At 6 years, the discontinuation rate was higher for SGLT-2i users (52%) compared to GLP-1 RA users (44%).
In a per-protocol analysis, SGLT-2i users showed a higher risk of foot ulcers and lower-limb amputation.
Surveillance differences may have introduced detection bias, particularly for neuropathy outcomes.
After inverse probability of treatment weighting, baseline characteristics were balanced between the two groups.
Clinical Implications
Clinicians should consider the differential risks of diabetic foot disease when prescribing SGLT-2 inhibitors versus GLP-1 receptor agonists. The findings suggest that SGLT-2 inhibitors may offer a protective effect against peripheral neuropathy, which is a critical consideration in long-term diabetes management.
Conclusion
Highlight the need for further research addressing detection bias and limitations.
Researchers found that patients with higher waist circumference and lower grip strength had the greatest risk for developing type 2 diabetes during long-term follow-up.
