Should We Be Concerned About SGLT-2 Inhibitors Worsening Peripheral Artery Disease?

Some studies have suggested that sodium–glucose cotransporter-2 (SGLT-2) inhibitors are associated with modest excess risk for adverse peripheral arterial disease (PAD) events (NEJM JW Gen Med Sep 15 2018 and JAMA Intern Med 2018; 178:1190; NEJM JW Gen Med Aug 1 2017 and N Engl J Med 2017; 377:644). To examine this concern further, researchers conducted a retrospective study of U.S. veterans with diabetes who were treated with metformin, insulin, sulfonylurea, or combinations of them. About 76,000 patients who received additional treatment with SGLT-2 inhibitors (usually empagliflozin) were compared with 76,000 propensity-matched patients who received add-on treatment with dipeptidyl peptidase-4 (DPP-4) inhibitors. Median age was 69, and me…