Presentation Details
| Preoperative sodium-glucose co-transporter 2 inhibitors provide mortality benefit among patients with type 2 diabetes and heart failure Una E.Choi1, Adriana Oprea2, BobbieJean Sweitzer3, David L.Hepner1. 1Brigham and Women's Hospital, Boston, MA.2Yale School of Medicine, New Haven, CT.3Inova Health System, Fairfax, VA |
Abstract
BACKGROUND: Sodium-glucose co-transporter 2 inhibitor (SGLT2i) drugs are used in the management of type 2 diabetes mellitus (T2DM) and heart failure (HF). Among non-surgical patients, SGLT2i reduce HF hospitalizations and cardiovascular deaths. Further evaluation is needed to determine SGLT2i's postoperative cardiovascular impacts for patients with and without HF.
METHODS: We conducted a retrospective cohort study (01/01/2005 to 01/01/2020) of adult surgical patients with T2DM from a large claims and electronic health records database (TriNetX Research Network). We compared: (1) patients without HF taking SGLT2i drugs vs. other T2DM medications (thiazolidinediones, insulin, biguanides, dipeptidyl peptidase 4 inhibitors, alpha glucosidase inhibitors, sulfonylureas or glucagon-like-peptide-1 analogues) and (2) patients with HF taking SGLT2i vs. non-SGLT2i. We propensity-score matched patients on age, demographics, surgical procedure, hemoglobin A1c, anion gap, glomerular filtration rate, albumin, chronic kidney disease, obesity, neoplasms, stroke, lipid disorders, peripheral vascular disease, other heart disease, nicotine dependence, socioeconomic hazards, and medication use such as insulin. Outcomes of interest included mortality, stroke, myocardial infarction (MI), euglycemic diabetic ketoacidosis (eDKA), acute kidney injury (AKI), postoperative anion gap, lactate, and major adverse cardiovascular events (MACE), defined as a composite of mortality, MI and stroke. Neoplasms were our negative control.
RESULTS: (1) SGLT2i significantly reduced the risk of AKI (0.43% vs. 0.84%, relative risk (RR) 0.51 [95% confidence interval 0.39-0.66]) and an increase in postoperative anion gap (10.2 vs. 9.2 mEq/L, p=0.01) in patients without HF, (Table 1). (2) Patients with HF taking SGLT2i drugs had lower mortality (0.56% vs. 1.09%, RR 0.52 [0.27-0.99] and AKI (3.82% vs. 5.71%, RR 0.70 [0.52-0.86]) without an increase in anion gap.
CONCLUSIONS: In all comparisons, there were no differences in eDKA risk. Patients with HF taking SGLT2i had lower mortality and AKI compared to those taking other T2DM medications, suggesting SGLT2i have particular perioperative benefits in this population.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
METHODS: We conducted a retrospective cohort study (01/01/2005 to 01/01/2020) of adult surgical patients with T2DM from a large claims and electronic health records database (TriNetX Research Network). We compared: (1) patients without HF taking SGLT2i drugs vs. other T2DM medications (thiazolidinediones, insulin, biguanides, dipeptidyl peptidase 4 inhibitors, alpha glucosidase inhibitors, sulfonylureas or glucagon-like-peptide-1 analogues) and (2) patients with HF taking SGLT2i vs. non-SGLT2i. We propensity-score matched patients on age, demographics, surgical procedure, hemoglobin A1c, anion gap, glomerular filtration rate, albumin, chronic kidney disease, obesity, neoplasms, stroke, lipid disorders, peripheral vascular disease, other heart disease, nicotine dependence, socioeconomic hazards, and medication use such as insulin. Outcomes of interest included mortality, stroke, myocardial infarction (MI), euglycemic diabetic ketoacidosis (eDKA), acute kidney injury (AKI), postoperative anion gap, lactate, and major adverse cardiovascular events (MACE), defined as a composite of mortality, MI and stroke. Neoplasms were our negative control.
RESULTS: (1) SGLT2i significantly reduced the risk of AKI (0.43% vs. 0.84%, relative risk (RR) 0.51 [95% confidence interval 0.39-0.66]) and an increase in postoperative anion gap (10.2 vs. 9.2 mEq/L, p=0.01) in patients without HF, (Table 1). (2) Patients with HF taking SGLT2i drugs had lower mortality (0.56% vs. 1.09%, RR 0.52 [0.27-0.99] and AKI (3.82% vs. 5.71%, RR 0.70 [0.52-0.86]) without an increase in anion gap.
CONCLUSIONS: In all comparisons, there were no differences in eDKA risk. Patients with HF taking SGLT2i had lower mortality and AKI compared to those taking other T2DM medications, suggesting SGLT2i have particular perioperative benefits in this population.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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