Are Cardiovascular Benefits and Adverse Effects of SGLT-2 Inhibitors Dependent on Baseline Glycosylated Hemoglobin Level?

Sodium–glucose cotransporter-2 (SGLT-2) inhibitors are used to manage type 2 diabetes but also have protective cardiovascular and renal effects. Because SGLT-2 inhibitors induce glucosuria, they are associated with volume depletion, mycotic urinary tract infections, and diabetic ketoacidosis. Do these benefits and adverse effects vary according to baseline level of hyperglycemia? To find out, researchers conducted a retrospective study of 145,000 commercially insured patients (mean age, 62) with type 2 diabetes, categorized by baseline glycosylated hemoglobin (HbA_1c) levels.

Patients who began using SGLT-2 inhibitors were compared with propensity-score–matched patients who initiated dipeptidyl peptidase-4 (DPP-4) inhibitors, within three cat…