(112) Differences in Heart Failure Hospitalization Risk Following Initiating SGLT2 Inhibitors Vs. DPP4 Inhibitors Across Race/Ethnicity and Rural/Urban Areas

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 443

Presenting Author(s)

Serena Jingchuan Guo, MP PhD
– Assistant Professor, University of Florida Department of Pharmaceutical Outcomes and Policy, University of Florida , Gainesville, Florida, United States

Co-Author(s)

Yujia Li
– University of Florida, Gainesville, Florida, United States
Jiang Bian
– Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, United States
Daniel T Lackland
– Medical University of South Carolina, United States
Stephen E. Kimmel, MD, MSCE, FISPE
– University of Florida, Gainesville, Florida, United States
Desmond A Schatz
– University of Florida, United States
Almut Winterstein, PhD, FISPE
– Distinguished Professor, University of Florida, Gainesville, Florida, United States

Background: Racial and rural disparities exist in the adoption of newer, more effective antidiabetic agents, including sodium-glucose cotransporter 2 (SGLT2) inhibitors.

Objectives: We aimed to evaluate whether the effectiveness of SGLT2i varied across race/ethnicity and rural/urban areas.

Methods: Using claims data from 15% random samples of national Medicare beneficiaries and the entire Florida Medicare beneficiaries, we identified individuals who had type 2 diabetes and initiated SGLT2 inhibitors or dipeptidyl peptidase-4 inhibitors (DPP4 inhibitors, as the active control) between 1/1/2017 and 12/31/2018. Cohort entry was the day of the first filled prescription of any SGLT2 inhibitors or DPP4 inhibitors, defined as no use of either in the prior year. The outcome was hospitalization for heart failure (HHF). We followed individuals until HHF, death or 12/31/2018. Inverse probability treatment weighting (IPTW) Cox regressions were applied, controlling for pre-exposure covariates. IPTW models were fitted separately across subgroups.

Results: Cohort mean age was 72 (SD 10), 53% were women and 2.2% (2,577 / 116,751) experienced HHF over a median follow up of 363 days. Compared with DPP4 inhibitors, SGLT2 inhibitors were associated with a lower risk of HHF (HR, 0.73; CI, 0.65–0.80). In the subgroup analyses, the beneficial effect of SGLT2 inhibitors vs. DPP4 inhibitors were comparable across non-Hispanic White (HR, 0.77; CI, 0.68–0.87), non-Hispanic Black (HR, 0.67; CI, 0.49–0.91) and Hispanic (HR, 0.68; CI, 0.50–0.92) groups. SGLT2 inhibitors associated decreased risk of HHF was only seen in individuals living in urban areas (HR, 0.69; CI, 0.61–0.78) but not rural areas (HR, 0.95; CI, 0.76–1.19).

Conclusions: Use of SGLT2 inhibitors, vs. DPP4 inhibitors, was associated with a lower risk of HHF and the effectiveness were comparable across racial and ethnics groups. However, SGLT2 inhibitors’ HHF benefit appeared to have been attenuated in those living rural areas. Future studies are warranted to understand the mechanisms underlying the potential rural-urban disparities in treatment outcomes.