Abstract
Aim: To investigate the effect of dipeptidyl peptidase-4 inhibitors (DPP4-Is) and glucagon-like peptide-1 receptor agonists (GLP1-RAs) on diabetic foot ulcer (DFU) and DFU-related outcomes (lower limb amputation [LLA], DFU-related hospitalization and mortality). Methods: We performed a cohort study with data from the Clinical Practice Research Datalink Aurum database with linkage to hospital data. We included people with type 2 diabetes starting treatment with metformin. Then we propensity score matched new users of DPP4-Is and sulphonylureas (N = 98 770), and new users of GLP1-RAs and insulin (N = 25 422). Cox proportional hazards models estimated the hazard ratios (HRs) for the outcomes. Results: We observed a lower risk of DFU with both DPP4-I use versus sulphonylurea use (HR 0.88, 95% confidence interval [CI]: 0.79-0.97) and GLP1-RA use versus insulin use (HR 0.44, 95% CI: 0.32-0.60) for short-term exposure (<= 400 days) and HR 0.74 (95% CI: 0.60-0.92) for long-term exposure (>400 days). Furthermore, the risks of hospitalization and mortality were lower with both DPP4-I use and GLP1-RA use. The risk of LLA was lower with GLP1-RA use. The results remained consistent across several sensitivity analyses. Conclusions: Incretin-based therapy was associated with a lower risk of DFU and DFU-related outcomes. This suggests benefits for the use of this treatment in people at risk of DFU.
Original language | English |
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Pages (from-to) | 3764-3780 |
Number of pages | 17 |
Journal | Diabetes Obesity & Metabolism |
Volume | 26 |
Issue number | 9 |
Early online date | 1 Jul 2024 |
DOIs | |
Publication status | Published - Sept 2024 |
Keywords
- amputation
- cohort study
- diabetic foot ulcer
- DPP4-Is
- GLP1-RAs
- incretins
- type 2 diabetes
- DIPEPTIDYL PEPTIDASE-4 INHIBITORS
- PERIPHERAL ARTERIAL-DISEASE
- RECEPTOR AGONISTS
- MORTALITY
- METAANALYSIS
- ANGIOGENESIS
- AMPUTATION
- BURDEN