ArticleBMJ (Clinical research ed.)2024
SGLT-2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors and risk of hyperkalemia among people with type 2 diabetes in clinical practice: population based cohort study.
Article in BMJ (Clinical research ed.), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed.
- Impact of the Four Pillars on Electrolyte Derangements during State-of-the-Art Therapy for Diabetic Kidney Disease.Electrolyte & blood pressure : E & BP · 2026Review
- Risk of Hyperkalemia in Patients with Heart Failure Treated with Spironolactone in Combination with Sacubitril/Valsartan vs. Renin-Angiotensin System Inhibitors.Clinical pharmacology and therapeutics · 2026Article
- Ameliorative effects of Wiryeongtang (herbal medicine) on cardiorenal complications via modulation of inflammatory and fibrotic responses in diabetic mice.Integrative medicine research · 2026Article
- A clinical and experimental investigation of liraglutide effects on the brain-kidney axis.Science advances · 2026Article
- Potassium and the kidney.Nature reviews. Nephrology · 2026Review
- Real-world evidence for comparative safety of second-line antihyperglycemic agents in older adults with type 2 diabetes.Nature communications · 2026Article
- GLP-1 receptor agonists and next-generation metabolic hormone therapies in chronic kidney disease.Nature reviews. Nephrology · 2026Review
- SGLT2 inhibitors, GLP-1 RAs, and DPP4 inhibitors and the risk of hypomagnesemia in type 2 diabetes: A target trial emulation.PLoS medicine · 2026Article
- Comparison of SGLT-2i and GLP-1RA on cardiovascular and renal outcomes in elderly patients with T2DM: a single-center retrospective cohort study.International urology and nephrology · 2026Article
- Cardiovascular safety of 5α-reductase inhibitors in people with benign prostatic hyperplasia and type 2 diabetes: a propensity score-matched analysis.European heart journal. Cardiovascular pharmacotherapy · 2026Article
- A scoping review of real-world evidence generation methods to estimate the safety of type 2 diabetes medications on fracture risk.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Intermittent energy restriction and risk of physician-diagnosed diabetes progression: a propensity-weighted real-world cohort study.Frontiers in nutrition · 2026Article
- Hesperetin and Naringenin promote glucagon-like peptide-1 secretion from L-cell through activation of TGR5 and alleviated type 2 diabetes.Frontiers in pharmacology · 2026Article
- Association between serum potassium and 28-day mortality in elderly patients with sepsis: a multicenter cohort study.BMC geriatrics · 2025Article
- Sodium-glucose cotransporter-2 inhibitors and risk of autoimmune rheumatic diseases: population based cohort study.BMJ (Clinical research ed.) · 2025Article
- Water and electrolyte abnormalities in novel pharmacological agents for kidney disease and cancer.Clinical and experimental nephrology · 2025Review
- Antihypertensive combinations: mind the potassium.Hypertension research : official journal of the Japanese Society of Hypertension · 2025Article
- Real-world effect of intermittent calorie-restricted diet on type 2 diabetes remission: a dual-cohort retrospective study.Frontiers in nutrition · 2025Article
- Diabetic kidney disease-Recent updates.Journal of diabetes · 2024Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectivesTo evaluate the comparative effectiveness of sodium-glucose cotransporter-2 (SGLT-2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase-4 (DPP-4) inhibitors in preventing hyperkalemia in people with type 2 diabetes in routine clinical practice.
designPopulation based cohort study with active-comparator, new user design.
settingClaims data from Medicare and two large commercial insurance databases in the United States from April 2013 to April 2022.
participants1:1 propensity score matched adults with type 2 diabetes newly starting SGLT-2 inhibitors versus DPP-4 inhibitors (n=778 908), GLP-1 receptor agonists versus DPP-4 inhibitors (n=729 820), and SGLT-2 inhibitors versus GLP-1 receptor agonists (n=873 460).
main outcome measuresHyperkalemia diagnosis in the inpatient or outpatient setting. Secondary outcomes were hyperkalemia defined as serum potassium levels ≥5.5 mmol/L and hyperkalemia diagnosis in the inpatient or emergency department setting.
resultsStarting SGLT-2 inhibitor treatment was associated with a lower rate of hyperkalemia than DPP-4 inhibitor treatment (hazard ratio 0.75, 95% confidence interval (CI) 0.73 to 0.78) and a slight reduction in rate compared with GLP-1 receptor agonists (0.92, 0.89 to 0.95). Use of GLP-1 receptor agonists was associated with a lower rate of hyperkalemia than DPP-4 inhibitors (0.79, 0.77 to 0.82). The three year absolute risk was 2.4% (95% CI 2.1% to 2.7%) lower for SGLT-2 inhibitors than DPP-4 inhibitors (4.6%
conclusionsIn people with type 2 diabetes, SGLT-2 inhibitors and GLP-1 receptor agonists were associated with a lower risk of hyperkalemia than DPP-4 inhibitors in the overall population and across relevant subgroups. The consistency of associations among individual agents in the SGLT-2 inhibitor and GLP-1 receptor agonist classes suggests a class effect. These ancillary benefits of SGLT-2 inhibitors and GLP-1 receptor agonists further support their use in people with type 2 diabetes, especially in those at risk of hyperkalemia.
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