All-Cause Mortality in Patients With Diabetes Under Treatment With Dapagliflozin: A Population-Based, Open-Cohort Study in The Health Improvement Network Database.
Empagliflozin was found to decrease mortality in patients with type 2 diabetes mellitus (T2DM) and a prior cardiovascular disease (CVD) event.



To establish whether these benefits can be replicated in a real-world setting, should be expected with the use of dapagliflozin, and apply to T2DM patients at low risk of CVD.



General practice, population-based, retrospective cohort study (January 2013 to September 2015).



The Health Improvement Network database.



A total of 22,124 T2DM patients (4444 exposed to dapagliflozin; 17,680 unexposed T2DM patients) matched for age, sex, body mass index, T2DM duration, and smoking.



The primary outcome was all-cause mortality (high and low risk for CVD) in the total study population, expressed as the adjusted incidence rate ratio (aIRR) with 95% confidence intervals (CIs). As a secondary analysis in the low-risk population, all-cause mortality and incident CVD were considered.



Patients with T2DM exposed to dapagliflozin were significantly less likely to die of any cause (aIRR: 0.50; 95% CI: 0.33 to 0.75; P = 0.001). Similarly, in low-risk patients, death from any cause was significantly lower in the cohort exposed to dapagliflozin (aIRR: 0.44; 95% CI: 0.25 to 0.78; P = 0.002). The difference in the risk of incident CVD did not reach statistical significance between groups in low-risk patients (aIRR: 0.89; 95% CI: 0.61 to 1.31; P = 0.546).



Patients with T2DM who were exposed to dapagliflozin had a lower risk of death from any cause irrespective of baseline CVD status.
Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom.|Department of Endocrinology, 424 General Military Hospital, Thessaloniki 56429, Greece.
Konstantinos A
KA
Toulis
Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom.
Brian H
BH
Willis
Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom.
Tom
T
Marshall
Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom.
Balachadran
B
Kumarendran
Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom.
Krishna
K
Gokhale
Diabetes Department, University Hospitals Birmingham, NHS Foundation Trust, Birmingham B15 2TH, United Kingdom.
Sandip
S
Ghosh
Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom.
G Neil
GN
Thomas
Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom.
Kar Keung
KK
Cheng
Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, United Kingdom.|Diabetes Department, University Hospitals Birmingham, NHS Foundation Trust, Birmingham B15 2TH, United Kingdom.
Parth
P
Narendran
Diabetes Department, University Hospitals Birmingham, NHS Foundation Trust, Birmingham B15 2TH, United Kingdom.
Wasim
W
Hanif
Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom.|Diabetes Department, University Hospitals Birmingham, NHS Foundation Trust, Birmingham B15 2TH, United Kingdom.
Krishnarajah
K
Nirantharakumar
D000368:Aged; D001559:Benzhydryl Compounds / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D016022:Case-Control Studies; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005960:Glucosides / Q000627:therapeutic use*; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000453:epidemiology; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology
D001559:Benzhydryl Compounds; D005960:Glucosides; D007004:Hypoglycemic Agents; C529054:dapagliflozin