Early GLP-1 Receptor Agonist and SGLT2 Inhibitor Add-On Strategies in Adults With Obesity, Type 2 Diabetes, Cardiovascular-Kidney-Metabolic Syndrome Stage 2-3, and Metabolic Dysfunction-Associated Steatotic Liver Disease

Overview

This retrospective observational target-trial emulation uses electronic health record data from the TriNetX US Collaborative Network to compare early treatment intensification strategies in adults with obesity, type 2 diabetes, cardiovascular-kidney-metabolic syndrome stage 2-3, and metabolic dysfunction-associated steatotic liver disease who initiate a GLP-1 receptor agonist or an SGLT2 inhibitor. The study compares patients who, within 90 days of starting background therapy, add the alternate agent, add usual-care glucose-lowering therapy, or do not receive early add-on therapy. Usual-care add-on therapy includes DPP-4 inhibitors, sulfonylureas, or insulin. The primary outcome is all-cause mortality over 60 months, with major cardiovascular events, major kidney events, and major liver outcomes also evaluated. Propensity-score methods are used to reduce bias from nonrandom treatment selection.

Conditions

Eligibility