All-cause mortality in patients with diabetes under glucagon-like peptide 1 agonists: a population-based, open cohort study

Aim: The glucagon-like peptide-1 receptor agonist (GLP1a) liraglutide has been described to benefit patients with type 2 diabetes mellitus (T2DM) at high cardiovascular risk. However, there are still uncertainties relating to these cardiovascular benefits: whether they also apply to an unselected diabetic population that includes low-risk patients, represent a class-effect, and could be observed in a real-world setting. 

Methods: We conducted a population-based, retrospective open cohort study using data derived from The Health Improvement Network database between Jan 2008 to Sept 2015. Patients with T2DM exposed to GLP1a (n=8,345) were compared to age, gender, body mass index, duration of T2DM and smoking status-matched patients with T2DM unexposed to GLP1a (n=16,541).

Results: Patients with diabetes receiving GLP1a were significantly less likely to die from any cause compared to matched control patients with diabetes (Adjusted Incidence Rate Ratio-aIRR: 0.64, 95% CI: 0.56-0.74, p-value < 0.0001). Similar findings were observed in low-risk patients (aIRR: 0.64, 95% CI: 0.53-0.76, p-value = 0.0001). No significant difference in the risk of incident CVD was detected in them (aIRR: 0.93, 95% CI: 0.83-1.12). Subgroup analyses, suggested that effect is persistent in the elderly or across glycated heamoglobin categories.

 Conclusions: GLP1a treatment in a real-world setting may confer additional mortality benefit in patients with T2DM irrespective of their baseline CVD risk, age or baseline glycated heamoglobin, and was sustained over the observation period.