Objective: This study evaluates the real-world effectiveness and safety of sodium-glucose cotransporter 2 (SGLT2) inhibitors in individuals with diabetes of the exocrine pancreas (DEP), given the limited research on effective pharmacological treatments for this condition.
Research Design and Methods: A retrospective cohort study was conducted on 66,120 individuals with DEP who initiated glucose-lowering drugs (GLDs) between September 2014 and December 2022, using data from the Korean National Health Insurance Service database. Propensity scores were developed for 1:1 matching between patients initiating SGLT2 inhibitors and those initiating other GLDs. Effectiveness outcomes included major adverse cardiovascular events (MACEs), heart failure, end-stage kidney disease (ESKD), and all-cause mortality. Safety outcomes included hypoglycemia, diabetic ketoacidosis, genital infections, urinary tract infections, fractures, and pancreatitis.
Results: After matching, 4,128 pairs of SGLT2 inhibitor and other GLD users were included, with a mean follow-up of 2.3 years. Compared to other GLDs, use of SGLT2 inhibitors was associated with a significantly lower risk of MACE (hazard ratio [HR] 0.69; 95% confidence interval [CI] 0.51–0.93), hospitalization for heart failure (0.70; 0.51–0.95), ESKD (0.19; 0.06–0.61), and all-cause mortality (HR 0.38; 95% CI 0.27–0.53). For safety outcomes, SGLT2 inhibitor use was associated with a reduced risk of urinary tract infections (HR 0.87; 95% CI 0.78–0.96) and pancreatitis (HR 0.71; 95% CI 0.58–0.87).
Conclusions: We found that SGLT2 inhibitors were associated with reduced cardiorenal outcomes and all-cause mortality risk and were safely used in patients with DEP.