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 languageEnglish
Pages (from-to)3764-3780
Number of pages17
JournalDiabetes Obesity & Metabolism
Volume26
Issue number9
Early online date1 Jul 2024
DOIs
Publication statusPublished - 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

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