Should Patients with New Diabetes Receive SGLT-2 Inhibitors Before Metformin?

Although those who initiated sodium–glucose cotransporter-2 inhibitors had fewer hospitalizations for heart failure, starting these agents before metformin is not indicated.

Sodium–glucose cotransporter-2 (SGLT-2) inhibitors prevent heart failure–related hospitalizations (NEJM JW Gen Med Jun 1 2022 and Ann Intern Med 2022 Apr 12; [e-pub]), but we don't know whether patients with diabetes could attain greater benefit by starting SGLT-2 inhibitors before guideline-recommended first-line metformin. U.S. investigators used commercial insurance and Medicare databases to retrospectively compare cardiovascular outcomes in >25,000 propensity-matched patients who started either an SGLT-2 inhibitor (i.e., canagliflozin, dapagliflozin, or empagliflozin) or metformin as initial therapy for type 2 diabetes.

After median follow-up of ≈7 months, patients who initiated SGLT-2 inhibitors had significantly lower risks for hospita…

Reviewing Author

Daniel D. Dressler, MD, MSc, MHM, FACP

Disclosures

RoyaltiesMcGraw-Hill; Elsevier

Editorial BoardsMedical Clinics of North America; Caribbean Medical Journal International Advisory Panel (2021–2026)

Daniel D. Dressler, MD, MSc, MHM, FACP

Disclosures

RoyaltiesMcGraw-Hill; Elsevier

Editorial BoardsMedical Clinics of North America; Caribbean Medical Journal International Advisory Panel (2021–2026)

Should Patients with New Diabetes Receive SGLT-2 Inhibitors Before Metformin?

Topics

Reviewing Author