A recent study published in Scientific Reports has revealed that liraglutide may offer better cardiovascular and renal protection compared to dulaglutide in Asian patients with type 2 diabetes mellitus (T2DM). The real-world study, utilizing data from the Chang Gung Research Database (CGRD) in Taiwan, highlights potential differences in outcomes between the two GLP-1 receptor agonists (RAs) in this specific population. The findings could influence treatment decisions for T2DM management in Asian healthcare settings.
The study, led by researchers in Taiwan, analyzed electronic medical records from the CGRD, which encompasses data from multiple centers within the Chang Gung Memorial Healthcare System. The system handles approximately 8.6 million outpatient visits and 370,000 admissions annually, representing a substantial portion of the Taiwanese population.
Study Design and Patient Population
The study included patients over 20 years of age with T2DM who initiated treatment with either liraglutide or dulaglutide between January 1, 2016, and December 31, 2022. Patients with type 1 diabetes, gestational diabetes, or those using other GLP-1 RAs were excluded. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal ischemic stroke. Secondary outcomes included heart failure admission, all-cause death, hypoglycemia, and a composite renal outcome comprising new macroalbuminuria, doubling of serum creatinine, worsening of estimated glomerular filtration rate (eGFR), and progression to dialysis.
Key Findings
After adjusting for baseline characteristics using inverse probability of treatment weighting (IPTW), the study found that liraglutide was associated with a significantly lower risk of cardiovascular events compared to dulaglutide. The researchers used the Cox proportional hazard model to compare the risk of fatal outcomes between groups. Furthermore, liraglutide demonstrated better renal outcomes, with a reduced risk of kidney function decline and progression to dialysis, analyzed using the Fine and Gray subdistribution hazard model.
Statistical Analysis
The inverse probability of treatment weighting (IPTW) method, based on propensity scores, was employed to balance the distribution of baseline characteristics between the liraglutide and dulaglutide study groups. Propensity scores were estimated using generalized boosted modeling with 10,000 trees. All outcome comparisons were made in the IPTW-adjusted cohort, with statistical significance set at a two-sided P < 0.05.
Implications for Clinical Practice
These findings suggest that liraglutide may offer superior cardiovascular and renal protection compared to dulaglutide in Asian patients with T2DM. Clinicians should consider these potential differences when selecting GLP-1 RA therapy for this population, particularly in individuals at high risk for cardiovascular or renal complications. Further research is warranted to confirm these findings in other populations and to elucidate the underlying mechanisms responsible for the observed differences.
