Evaluating risks and benefits of Newer Diabetes medications when Used in Routine care (ENDURe)
Bibliographic record
Abstract
Abstract Introduction Sodium glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 analogues (GLP1a) improve clinical outcomes (e.g., myocardial infarction, stroke, death from CV causes) for adults with type 2 diabetes mellitus. The majority of available data from clinical trials and observational studies are from outpatients. Data on their effectiveness among hospitalized patients, however, are lacking. Methods We conducted a multicentre, retrospective, cohort study of adults aged 65 years and older with type 2 diabetes mellitus hospitalized between 2017 and 2023 in Ontario. We compared adults newly prescribed an SGLT2i or GLP1a in hospital to adults newly prescribed a DPP4i in hospital. In a sensitivity analysis, new use of sulfonylurea was the comparator. Our primary outcome was the 1-year risk of a composite of all-cause mortality, hospitalization with myocardial infarction, stroke, heart failure, or renal failure. Secondary outcomes included components of the composite, short-term (i.e., 30 day) risk of hypoglycemia, and the 1-year risk of DKA. Results We identified 6,713 older adults with diabetes who were newly prescribed one of the following medications during an inpatient hospitalization: SGLT2i (N=1520), GLP1 (N=90), DPP4i (N=3726), sulfonylurea (N=1377). Because new use of GLP1 was rare in hospital, we updated our exposure group to SGLT2i alone. Adults who received an SGLT2i were typically younger, and more likely to have heart failure or coronary artery disease compared to adults who received a DPP4i or sulfonylurea. Among adults who received an SGLT2i, at 1-year the primary outcome occurred in 26% compared to 31% who newly received a DPP4i (adjusted hazard ratio [HR] 0.82 95% Confidence Interval [CI] 0.69,0.97). In our sensitivity analysis using sulfonylurea as the comparator group, the hazard ratio for the primary outcome was 0.97 (95% CI 0.80, 1.18). We did not identify an increased risk of DKA or hypoglycemia for SGLT2i compared to DPP4i, though patients receiving an SGLT2i did have a lower rate of 30-day readmission (HR 0.73, 95%CI 0.58-0.92). Conclusion Among older adults with type 2 diabetes mellitus, newly prescribing an SGLT2i or GLP1 during a hospitalization was uncommon. New use of an SGLT2i was associated with improved outcomes compared to DPP4i but this finding was not robust when new use of a sulfonylurea was the comparator. Future larger studies are needed to provide more definitive results.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".