BackgroundThis study investigated whether initial SGLT2 (sodium‐glucose cotransporter 2) inhibitor‐based treatment is superior to metformin‐based regimens as a primary prevention strategy among low‐risk patients with diabetes.Methods and ResultsIn this nationwide cohort study, a total of 38 496 patients with diabetes with low cardiovascular risk were identified (age 62.0±11.6 years, men 50%) from January 1 to December 31, 2016. Patients receiving SGLT2 inhibitors‐based and metformin‐based regimens were 1:2 matched by propensity score. Study outcomes included all‐cause mortality, cardiovascular death, hospitalization for heart failure, stroke, and progression to end‐stage renal disease. Compared with 1928 patients receiving metformin‐based regimens, 964 patients receiving SGLT2 inhibitor‐based regimens had similar all‐cause mortality (hazard ratio [HR], 0.75 [95% CI, 0.51–1.12]), cardiovascular death (HR, 0.69 [95% CI, 0.25–1.89]), hospitalization for heart failure (HR, 1.06 [95% CI, 0.59–1.92]), stroke (HR, 0.78 [95% CI, 0.48–1.27]), and progression to end‐stage renal disease (HR, 0.88 [95% CI, 0.32–2.39]). However, SGLT2 inhibitors were associated with a lower risk of all‐cause mortality (HR, 0.47 [95% CI, 0.23–0.99]; P for interaction=0.008) and progression to end‐stage renal disease (HR, 0.22 [95% CI, 0.06–0.82]; P for interaction=0.04) in patients under the age of 65.ConclusionsIn comparison to metformin‐based regimens, SGLT2 inhibitor‐based regimens showed a similar risk of all‐cause mortality and adverse cardiorenal events. SGLT2 inhibitors might be considered as first‐line therapy in select low‐risk patients, for example, younger patients with diabetes.

中文翻译：

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钠葡萄糖转运蛋白 2 抑制剂与二甲双胍对低心血管风险糖尿病患者心血管和肾脏结局的影响：一项全国队列研究

背景本研究调查了基于 SGLT2（钠-葡萄糖协同转运蛋白 2）抑制剂的初始治疗作为低危糖尿病患者的一级预防策略是否优于基于二甲双胍的治疗方案。方法和结果在这项全国性队列研究中，共有 38 496 名患者2016年1月1日至12月31日期间确定了低心血管风险的糖尿病患者（年龄62.0±11.6岁，男性50%）。接受基于SGLT2抑制剂和基于二甲双胍的方案的患者按倾向评分进行1:2匹配。研究结果包括全因死亡率、心血管死亡、心力衰竭住院、中风以及进展为终末期肾病。与接受基于二甲双胍的治疗方案的 1928 名患者相比，接受基于 SGLT2 抑制剂的治疗方案的 964 名患者具有相似的全因死亡率（风险比 [HR]，0.75 [95% CI，0.51-1.12]）、心血管死亡（HR，0.69 [ 95% CI, 0.25–1.89]）、因心力衰竭住院（HR, 1.06 [95% CI, 0.59–1.92]）、卒中（HR, 0.78 [95% CI, 0.48–1.27]）和进展至晚期肾病阶段（HR，0.88 [95% CI，0.32–2.39]）。然而，SGLT2抑制剂与较低的全因死亡率风险（HR，0.47 [95% CI，0.23-0.99]；相互作用P = 0.008）和进展至终末期肾病（HR，0.22 [95%] CI，0.06-0.82]；65 岁以下患者的相互作用P = 0.04。结论与基于二甲双胍的治疗方案相比，基于 SGLT2 抑制剂的治疗方案显示出相似的全因死亡率和不良心肾事件风险。 SGLT2 抑制剂可能被视为特定低风险患者（例如年轻糖尿病患者）的一线治疗。