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<p>This retrospective study compared the clinical and metabolic effectiveness of empagliflozin (EMPA) versus dapagliflozin (DAPA) and dipeptidyl peptidase-4 inhibitors (DPP-4i) using real-world data from the Korean National Health Insurance Service (2013–2024). Adults with type 2 diabetes who initiated treatment and maintained it for &gt; 365 days were evaluated. Clinical and metabolic outcomes were analyzed using Cox models and linear mixed models, respectively, following 1:1 propensity score matching (<i>n</i> = 17,050 per group for EMPA vs. DAPA and EMPA vs. DPP-4i). Compared with DAPA, EMPA was associated with lower risks of hypoglycemia (adjusted hazard ratio [aHR] 0.60, 95% CI 0.44–0.82) and all-cause hospitalization (aHR 0.96, 95% CI 0.92–0.99). Compared with DPP-4i, EMPA was associated with lower risks of all-cause hospitalization (aHR 0.83, 95% CI 0.80–0.87) and kidney events (aHR 0.76, 95% CI 0.66–0.88). Acute safety outcomes, including hypoglycemia and diabetic ketoacidosis, were evaluated exploratorily because the sustained-exposure design may underrepresent early events. In conclusion, EMPA and DAPA showed broadly similar outcomes consistent with a class effect; however, EMPA was associated with lower risks of all-cause hospitalization and kidney events compared with DPP-4i. These associations should be interpreted cautiously given the observational study design.</p>

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Head-to-head comparative effectiveness of empagliflozin versus dapagliflozin and DPP-4 inhibitors on clinical and metabolic outcomes: a nationwide propensity-matched study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月24日

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  • Dong Hyeon Lee,
  • Hongsock Kim,
  • Seung-Hun You,
  • Youngoh Bae,
  • Hyounggyoon Yoo,
  • Beom-Seok Jeong,
  • Seung Won Lee,
  • Yil-Seob Lee,
  • Wonsuk Shin

摘要

This retrospective study compared the clinical and metabolic effectiveness of empagliflozin (EMPA) versus dapagliflozin (DAPA) and dipeptidyl peptidase-4 inhibitors (DPP-4i) using real-world data from the Korean National Health Insurance Service (2013–2024). Adults with type 2 diabetes who initiated treatment and maintained it for > 365 days were evaluated. Clinical and metabolic outcomes were analyzed using Cox models and linear mixed models, respectively, following 1:1 propensity score matching (n = 17,050 per group for EMPA vs. DAPA and EMPA vs. DPP-4i). Compared with DAPA, EMPA was associated with lower risks of hypoglycemia (adjusted hazard ratio [aHR] 0.60, 95% CI 0.44–0.82) and all-cause hospitalization (aHR 0.96, 95% CI 0.92–0.99). Compared with DPP-4i, EMPA was associated with lower risks of all-cause hospitalization (aHR 0.83, 95% CI 0.80–0.87) and kidney events (aHR 0.76, 95% CI 0.66–0.88). Acute safety outcomes, including hypoglycemia and diabetic ketoacidosis, were evaluated exploratorily because the sustained-exposure design may underrepresent early events. In conclusion, EMPA and DAPA showed broadly similar outcomes consistent with a class effect; however, EMPA was associated with lower risks of all-cause hospitalization and kidney events compared with DPP-4i. These associations should be interpreted cautiously given the observational study design.