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Sodium-glucose cotransporter-2 inhibitor in risk of sepsis/septic shock among patients with type 2 diabetes mellitus—a retrospective analysis of nationwide medical claims data

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Abstract

This research is an attempt to investigate the benefit of sodium-glucose cotransporter-2 inhibitor (SGLT2I) use in patients with diabetes mellitus (DM) for outcomes of sepsis/septic shock. We used Taiwan’s national data set to identify patients and patients’ characteristics to investigate sepsis/septic shock among diabetes patients who use SGLT2I compared to those who do not. We have compared the two groups for several relevant categories of potential risk factors for sepsis/septic shock and adjusted the Cox regression models accordingly. The adapted diabetes complications severity index (DCSI) was used for stratifying the advancing disease of DM. Compared to patients with DCSI = 0, patients with DCSI ≥ 2 had a significantly higher risk of sepsis/septic shock (adjusted HR = 1.52, 95% CI = 1.37–1.68). A significantly lower risk of sepsis/septic shock events was observed in the SGLT2I cohort than in the non-SGLT2I cohort with the DCSI groups [adjusted HR = 0.6 (DCSI group = 0), adjusted HR = 0.61 (DCSI group = 1), adjusted HR = 0.55 (DCSI group ≥ 2)]. Patients who received SGLT2I for a cumulative duration of ≥ 90 days had a significantly lower risk of sepsis/septic shock than patients with a duration of < 90 days (adjusted HR = 0.36, 95% CI = 0.34–0.39). We described a decreased risk of sepsis/septic shock among diabetic patients who took SGLT2I.

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Acknowledgements

We are grateful to Health Data Science Center, China Medical University Hospital for providing administrative, technical, and funding support.

Funding

This study is supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW112-TDU-B-212–144004), China Medical University (CMU110-AWARD-01), and China Medical University Hospital (DMR-HHC-110–4; DMR-111–105; DMR-112–009). No additional external funding was received for this study.

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Authors and Affiliations

  1. School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Wei-Syun Hu

  2. Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan

    Wei-Syun Hu

  3. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Cheng-Li Lin

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  1. Wei-Syun Hu
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All authors contributed to the manuscript. All were involved in the design of the study, collected the data, performed the statistical analysis, and wrote the manuscript, and all authors were involved in the final approval of the manuscript. The authors declare that all data were generated in-house and that no paper mill was used.

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Correspondence to Wei-Syun Hu.

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This study was approved by the Research Ethics Committee of China Medical University and Hospital (CMUH110-REC3-133(CR-2)).

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Hu, WS., Lin, CL. Sodium-glucose cotransporter-2 inhibitor in risk of sepsis/septic shock among patients with type 2 diabetes mellitus—a retrospective analysis of nationwide medical claims data. Naunyn-Schmiedeberg's Arch Pharmacol 397, 1623–1631 (2024). https://doi.org/10.1007/s00210-023-02685-1

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