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Dapagliflozin is as...
Dapagliflozin is associated with lower risk of cardiovascular events and all-cause mortality in people with type 2 diabetes (CVD-REAL Nordic) when compared with dipeptidyl peptidase-4 inhibitor therapy : A multinational observational study
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- Persson, Frederik (author)
- Steno Diabet Ctr, Copenhagen, Denmark.
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- Nystrom, Thomas (author)
- Karolinska Institutet
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- Jorgensen, Marit E. (author)
- Steno Diabet Ctr, Copenhagen, Denmark.
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- Carstensen, Bendix (author)
- Steno Diabet Ctr, Copenhagen, Denmark.
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- Gulseth, Hanne L. (author)
- Oslo Univ Hosp, Oslo, Norway.
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- Thuresson, Marcus (author)
- Statisticon AB, Uppsala, Sweden.
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- Fenici, Peter (author)
- AstraZeneca, Cambridge, England.
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- Nathanson, David (author)
- Karolinska Institutet
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- Eriksson, Jan W (author)
- Uppsala universitet,Klinisk diabetologi och metabolism
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- Norhammar, Anna (author)
- Karolinska Institutet
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- Bodegard, Johan (author)
- AstraZeneca Nord Balt, N-0601 Oslo, Norway.
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- Birkeland, Kare I. (author)
- Oslo Univ Hosp, Oslo, Norway.;Univ Oslo, Oslo, Norway.
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Karolinska Institutet Steno Diabet Ctr, Copenhagen, Denmark (creator_code:org_t)
- 2017-09-08
- 2018
- English.
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In: Diabetes, obesity and metabolism. - : Wiley. - 1462-8902 .- 1463-1326. ; 20:2, s. 344-351
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Abstract
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- Aims To compare the sodium-glucose-cotransporter-2 (SGLT-2) inhibitor dapagliflozin with dipeptidyl peptidase-4 (DPP-4) inhibitors with regard to risk associations with major adverse cardiovascular (CV) events (MACE; non-fatal myocardial infarction, non-fatal stroke or cardiovascular mortality), hospitalization for heart failure (HHF), atrial fibrillation and severe hypoglycaemia in patients with type 2 diabetes (T2D) in a real-world setting.Methods All patients with T2D prescribed glucose-lowering drugs (GLDs) during 2012 to 2015 were identified in nationwide registries in Denmark, Norway and Sweden. Patients were divided into two groups: new users of dapagliflozin and new users of DPP-4 inhibitors, matched 1:3 by propensity score, calculated by patient characteristics, comorbidities and drug treatment. Cox survival models were used to estimate hazard ratio (HR) per country separately, and a weighted average was calculated.Results After matching, a total of 40908 patients with T2D were identified as new users of dapagliflozin (n=10227) or a DPP-4 inhibitor (n=30681). The groups were well balanced at baseline; their mean age was 61years and 23% had CV disease. The mean follow-up time was 0.95years, with a total of 38760 patient-years. Dapagliflozin was associated with a lower risk of MACE, HHF and all-cause mortality compared with DPP-4 inhibitors: HRs 0.79 (95% confidence interval [CI] 0.67-0.94), 0.62 (95% CI 0.50-0.77), and 0.59 (95% CI 0.49-0.72), respectively. Numerically lower, but non-significant HRs were observed for myocardial infarction (0.91 [95% CI 0.72-1.16]), stroke (0.79 [95% CI 0.61-1.03]) and CV mortality (0.76 [95% CI 0.53-1.08]) Neutral associations with atrial fibrillation and severe hypoglycaemia were observed.Conclusions Dapagliflozin was associated with lower risks of CV events and all-cause mortality compared with DPP-4 inhibitors in a real-world clinical setting and a broad T2D population.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)
Keyword
- cardiovascular disease
- dapagliflozin
- diabetes complications
- DPP-4 inhibitor
- hypoglycaemia
- type 2 diabetes
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Persson, Frederi ...
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Nystrom, Thomas
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Jorgensen, Marit ...
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Carstensen, Bend ...
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Gulseth, Hanne L ...
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Thuresson, Marcu ...
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Fenici, Peter
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Nathanson, David
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Eriksson, Jan W
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Norhammar, Anna
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Bodegard, Johan
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Birkeland, Kare ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Endocrinology an ...
- Articles in the publication
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Diabetes, obesit ...
- By the university
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Uppsala University
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Karolinska Institutet