BMJ

Which diabetes drugs up hyperkalemia risks? GLP-1, SGLT-2, DPP-4

August 13, 2024

Starting dipeptidyl peptidase-4 inhibitors (DPP-4i) was linked to higher hyperkalemia risk than starting sodium-glucose cotransporter-2 inhibitors (SGLT-2i) or glucagon-like peptide-1 receptor agonists (GLP-1ra), in this database analysis of patients with type 2 diabetes.

• This population-based cohort study with active comparators investigated claims data from Medicare and 2 U.S. commercial insurers from 2013-2022. Propensity scores matched patients with type 2 diabetes who newly started a drug: SGLT-2i vs DPP-4i (N=778,908), GLP-1ra vs. DPP-4i (N=729,820), SGLT-2i vs. GLP-1ra (N=873,460).
• Drugs analyzed included SGLT-2i (canagliflozin, dapagliflozin, empagliflozin), GLP-1ra (dulaglutide, exenatide, liraglutide, semaglutide), and DPP-4i (gliptins).
• Hyperkalemia was defined as potassium 5.5 mmol/L or greater, or a diagnosis of hyperkalemia in an inpatient or outpatient setting.
• The 3-year absolute risk of hyperkalemia was 2.4% lower for SGLT-2i vs. DPP-4i, and 1.8% lower for GLP-1ra vs. DPP-4i.
• Correlations with hyperkalemia were consistent among various demographic and clinical patient subsets, and within each drug class.

Source:

Fu EL, et al. (2024, June 26). BMJ. SGLT-2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors and risk of hyperkalemia among people with type 2 diabetes in clinical practice: population based cohort study. https://pubmed.ncbi.nlm.nih.gov/38925801/