한빛사논문
Han Eol Jeong1,2†, Sohee Park1†, Yunha Noh1,2, Sungho Bea1, Kristian B. Filion3,4, Oriana H. Y. Yu4,5, Seung Hun Jang6, Young Min Cho7,8,9,10, Dong Keon Yon11,12 and Ju‑Young Shin1,2,13*
1School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
2Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea.
3Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
4Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.
5Division of Endocrinology and Metabolism, Jewish General Hospital, McGill University, Montreal, QC, Canada.
6Division of Pulmonary, Allergy, and Critical Care Medicine, College of Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, South Korea.
7Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
8Department of Translational Medicine, Seoul National University College of Medicine, Seoul, South Korea.
9Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
10Institute On Aging, Seoul National University, Seoul, South Korea.
11Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea.
12Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea.
13Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
†Han Eol Jeong and Sohee Park contributed equally to this work as co-frst authors.
*Correspondence: Ju‑Young Shin
Abstract
Background: Impaired respiratory function remains underrecognized in patients with type 2 diabetes (T2D), despite common pulmonary impairment. Meanwhile, there is little data available on the respiratory effects of sodium glucose cotransporter 2 inhibitors (SGLT2i). Hence, we examined the association between SGLT2i use and the risk of adverse respiratory events in a real-world setting.
Methods: We conducted a population-based, nationwide cohort study using an active-comparator new-user design and nationwide claims data of South Korea from January 2015 to December 2020. Among individuals aged 18 years or older, propensity score matching was done to match each new user of SGLT2is with dipeptidyl peptidase 4 inhibitors (DPP4is), with patients followed up according to an as-treated definition. The primary outcome was respiratory events, a composite endpoint of acute pulmonary edema, acute respiratory distress syndrome (ARDS), pneumonia, and respiratory failure. Secondary outcomes were the individual components of the primary outcome and in-hospital death. Cox models were used to estimate hazard ratios (HRs) and 95% CIs.
Results: Of 205,534 patient pairs in the propensity score matched cohort, the mean age of the entire cohort was 53.8 years and 59% were men, with a median follow-up of 0.66 years; all baseline covariates achieved balance between the two groups. Incidence rates for overall respiratory events were 4.54 and 7.54 per 1000 person-years among SGLT2i and DPP4i users, respectively, corresponding to a rate difference of 3 less events per 1000 person-years (95% CI - 3.44 to - 2.55). HRs (95% CIs) were 0.60 (0.55 to 0.64) for the composite respiratory endpoint, 0.35 (0.23 to 0.55) for acute pulmonary edema, 0.44 (0.18 to 1.05) for ARDS, 0.61 (0.56 to 0.66) for pneumonia, 0.49 (0.31 to 0.76) for respiratory failure, and 0.46 (0.41 to 0.51) for in-hospital death. Similar trends were found across individual SGLT2is, subgroup analyses of age, sex, history of comorbidities, and a range of sensitivity analyses.
Conclusions: These findings suggest a lower risk of adverse respiratory events associated with patients with T2D initiating SGLT2is versus DPP4is. This real-world evidence helps inform patients, clinicians, and guideline writers regarding the respiratory effects of SGLT2i in routine practice.
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