(30) Does Prescription of SGLT2i Decrease the Risk of COVID-19 in Adults with T2DM in the UK, Compared to Prescription of DPP4i: A CPRD Population-Based Observational Cohort Study

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 704

Presenting Author(s)

Owen A. Taylor
– Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Cambridge, Cambridgeshire, United Kingdom

Co-Author(s)

Rohini Mathur, PhD, MSc
– Associate Professor of Epidemiology, LSHTM, London, United Kingdom

Background: The risk of infection and adverse outcomes associated with Coronavirus disease 2019 (COVID-19) has been disproportionally higher in individuals with type II diabetes mellitus (T2DM). There has been conflicting evidence on the prescription of second-line diabetic medications, specifically sodium-glucose co-transporter-2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP-4i), in patients with COVID-19.

Objectives: To determine whether SGLT2i prescription decreases the risk of COVID-19 diagnosis or mortality, in adults with T2DM in the UK, compared to DPP-4i; and the role of ethnicity, index of multiple deprivation (IMD), country within UK, and waves of SARS-CoV-2 pandemic on each association of interest.

Methods: This observational prospective population-based cohort study used UK data from the Clinical Practice Research Datalink (CPRD) between 1st January and 30th November 2020. Exposure was classified as prescription of SGLT2i or DPP-4i in the one year prior to 1st January 2020. Cox Proportional Hazards Regression modelling was used to determine crude, multivariable and propensity score (PS) adjusted hazard ratios (HR) for SGLT2i prescription compared to DPP-4i on risk of COVID-19 diagnosis, and COVID-19 mortality.

Results: A total of 39,739 adults with T2DM were included in this study with 59% prescribed DPP-4i (n=23,450) and 41% prescribed SGLT2i (n=16,296). After adjustment for confounders, there was strong evidence for a 25% risk reduction in COVID-19 diagnosis associated with SGLT2i prescription (n=265) compared to DPP-4i (n=447) (HR 0.75, 95% CI 0.63-0.88, p=0.001). This finding remained consistent with PS adjustment (HR 0.75, 5% CI 0.64-0.87, p< 0.001) and sensitivity analyses. There was limited power to investigate COVID-19 mortality. There were 0.4% (n=35) records of COVID-19 as the underlying cause of death, 0.05% (n < 5) by SGLT2i and 0.4% (n=31) by DPP-4i prescriptions. The crude HR for this association was 0.23 (95% CI 0.08-0.66, p< 0.001).

Conclusions: This study found strong evidence for a protective effect of SGLT2i prescription on reducing COVID-19 diagnosis in adults with T2DM, in the UK, compared to DPP-4i. It is likely that some risk is accountable to factors not recorded on clinical records. In the context of the COVID-19 pandemic, this analysis adds to evidence that patients with a SGLT2i prescription should continue this medication due to clinically important differences in COVID-19 susceptibility.