Evidence map›Paper›PMID 41177308›Full record

ArticleDiabetes research and clinical practice2025

Risk of lower extremity complications with GLP-1 receptor agonists, SGLT2 inhibitors, and DPP-4 inhibitors in peripheral artery disease.

Alexander T Hong, Forest Lin, Ivan Y Luu, Laura Shin, Sukgu M Han, David G Armstrong, Tze-Woei Tan

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Diabetes research and clinical practice, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Review
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Alexander T HongKeck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Forest LinUniversity of South Florida Health Morsani College of Medicine, Tampa, FL, USA.
Ivan Y LuuKeck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Laura ShinKeck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Sukgu M HanKeck School of Medicine, University of Southern California, Los Angeles, CA, USA.
David G ArmstrongKeck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Tze-Woei TanKeck School of Medicine, University of Southern California, Los Angeles, CA, USA. Electronic address: tze-woei.tan@med.usc.edu.

Funding

Determinants in Limb Preservation in Hispanics and Native AmericansK23DK122126 · NIDDK · UNIVERSITY OF SOUTHERN CALIFORNIA · PI TAN, TZE-WOEI · 2019 to 2023
$845k
Evaluating the Feasibility and Acceptability of a Lifestyle Intervention to Prevent Recurrence of Diabetic Foot Ulcers: A Pilot StudyR03DK140420 · NIDDK · UNIVERSITY OF SOUTHERN CALIFORNIA · PI TAN, TZE-WOEI · 2024 to 2025
$249k
NIDDK NIH HHS K23 DK122126NIDDK NIH HHS R03 DK140420
6 · The paper itself

Abstract

aimsTo compare the association of glucagon-like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT2i), and dipeptidyl peptidase-4 inhibitors (DPP-4i) therapies on lower extremity vascular complications and mortality in PAD.

methodsWe conducted a retrospective cohort study using a nationwide U.S. electronic health records database. Adults with PAD and type 2 diabetes who initiated GLP-1RA, SGLT2i, or DPP4i therapy (May 2013-January 2025) were included. Propensity score matching (1:1) balanced baseline characteristics. Cox models estimated hazard ratios (HR) with 95 % confidence intervals (CI) for major amputation (primary outcome), lower extremity revascularization (LER), and all-cause mortality over 3 years follow-up. Subgroup analyses included symptomatic PAD, prior LER, and drug-level comparisons.

resultsGLP-1RAs were associated with lower risks of major amputation (HR 0.79 [95 % CI 0.70-0.90]), LER (HR 0.82 [0.76-0.88]), and mortality (HR 0.71 [0.68-0.73]) compared with SGLT2i (n = 77,393 each). Similar reductions were seen versus DPP-4is (n = 39,907 each); SGLT2is and DPP-4is showed comparable risks (n = 42,924 each). GLP-1RA benefits remained significant in symptomatic PAD (p < 0.05) and were associated with lower mortality in LER patients (p < 0.05). Semaglutide and tirzepatide showed the greatest benefit.

conclusionGLP-1RAs were associated with lower limb complication and mortality risks in PAD, supporting a potential vascular benefit that warrants prospective evaluation.

Indexed as

Dipeptidyl-Peptidase IV InhibitorsGlucagon-Like Peptide-1 ReceptorAmputation, SurgicalDiabetes Mellitus, Type 2FemaleHumansHypoglycemic AgentsMaleMiddle AgedPeripheral Arterial DiseaseSodium-Glucose Transporter 2 InhibitorsDipeptidyl-Peptidase IV InhibitorsGlucagon-Like Peptide-1 ReceptorHypoglycemic AgentsSodium-Glucose Transporter 2 InhibitorsDiabetes mellitusDipeptidyl peptidase-4 inhibitorsGlucagon-like peptide-1 receptor agonistsLimb amputationPeripheral artery diseaseSodium-glucose cotransporter-2 inhibitors

Identifiers

PMID41177308
PMCPMC12645714

What OpenQuestion holds

Textmetadata
LicenceTDM
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.