Dr. Ziyad Al-Aly

Diabetes: Comparative Effectiveness of SGLT2I vs Sulfonylureas All-Cause Mortality.

MedicalResearch.com Interview with:

Dr. Ziyad Al-Aly

Dr. Ziyad Al-Aly

Dr. Ziyad Al-Aly, MD, FASN
Clinical Epidemiology Center
Research and Development Service
Veterans Affairs St. Louis Health Care System
St. Louis, MO

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: There are several randomized controlled trials of  Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) but none (not a single study) provided a head-to-head comparison with sulfonylureas — the most commonly prescribed antihyperglycemics after metformin.

We resolved to leverage advanced methodologies to undertake a head-to-head investigation of the comparative effectiveness of SGLT2I vs sulfonylureas on the risk of all-cause mortality.

MedicalResearch.com: What should readers take away from your report?

Response: In people with diabetes already on metformin, initiation of SGLT2i was associated with lower risk of all-cause mortality compared with initiation of sulfonylureas.

This effect was evident regardless of cardiovascular disease status, regardless of albuminuria and eGFR.

Continued use of SGLT2i + metformin was superior to using SGLT2i alone (this is important as a lot of people are using SGLT2i alone and skipping metformin).  

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Clinical practice and guidelines should be informed by evidence. There is a tendency to skip metformin and jump into SGLT2i immediately. I think our results provide evidence that combined use of SGLT2i + metformin is better than SGLT2i alone. I think this area deserves more examination.

No disclosures


 Xie Y, Bowe B, Gibson AK, McGill JB, Maddukuri G, Al-Aly Z. Comparative Effectiveness of Sodium-Glucose Cotransporter 2 Inhibitors vs Sulfonylureas in Patients With Type 2 Diabetes. JAMA Intern Med. Published online June 28, 2021. doi:10.1001/jamainternmed.2021.2488


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Last Updated on June 29, 2021 by Marie Benz MD FAAD