Observational studyDiabetes care2020
Sodium-Glucose Cotransporter 2 Inhibitors and the Risk of Below-Knee Amputation: A Multicenter Observational Study.
Observational study in Diabetes care, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It reports registered trial NCT04017221. Cited by 15 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Safety of Sodium-glucose Cotransporter 2 (SGLT2) Inhibitors Among Patients With Type 2 Diabetes: a Multicenter Cohort Study
Open the trial in the graphWho cites it
15 citing papers in PubMed, 2 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- Safety of sodium-glucose transporter 2 (SGLT-2) inhibitors in patients with type 2 diabetes: a meta-analysis of cohort studies.Frontiers in pharmacology · 2023Pooled it
- Cardiovascular Benefits With Favorable Renal, Amputation and Hypoglycemic Outcomes of SGLT-2 Inhibitors in Type 2 Diabetes From the Asian Perspective: A Population-Based Cohort Study and Systematic Review.Frontiers in endocrinology · 2022Pooled it
- Amputation and gangrene associated with SGLT2 inhibitors: pharmacovigilance analysis of the FDA adverse event reporting system (FAERS) database.Journal of endocrinological investigation · 2026Article
- Evaluating the Effects of Glucagon-Like Peptide 1 Receptor Agonists as a Secondary Prevention in Peripheral Arterial Disease: A Meta-Analysis.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2026Article
- Elevated amputation rates in COVID-19 survivors: Insights from a large-scale Japanese cohort study.Journal of diabetes investigation · 2025Article
- Innovations in pharmacovigilance studies of medicines in older people.British journal of clinical pharmacology · 2025Review
- Comparison of Effectiveness Among Different Sodium-Glucose Cotransoporter-2 Inhibitors According to Underlying Conditions: A Network Meta-Analysis of Randomized Controlled Trials.Journal of the American Heart Association · 2024Article
- Association of sodium-glucose cotransporter 2 inhibitors with post-discharge outcomes in patients with acute heart failure with type 2 diabetes: a cohort study.Cardiovascular diabetology · 2023Article
- Denosumab and incidence of type 2 diabetes among adults with osteoporosis: population based cohort study.BMJ (Clinical research ed.) · 2023Article
- Risk of lower limb amputation in diabetic patients using SGLT2 inhibitorsTherapeutic advances in drug safety · 2023Article
- Effectiveness and safety of empagliflozin in routine care patients: Results from the EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study.Diabetes, obesity & metabolism · 2022Article
- Risk of lower extremity amputations in patients with type 2 diabetes using sodium-glucose co-transporter 2 inhibitors.Acta diabetologica · 2022Article
- Validity of an algorithm to identify cardiovascular deaths from administrative health records: a multi-database population-based cohort study.BMC health services research · 2021 · on this mapArticle
- Comparative Effectiveness and Safety of Sodium-Glucose Cotransporter 2 Inhibitors Versus Glucagon-Like Peptide 1 Receptor Agonists in Older Adults.Diabetes care · 2021Article
- Chronic Lower Extremity Ischemia and Its Association with the Frailty Syndrome in Patients with Diabetes.International journal of environmental research and public health · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors at 10 institutions in 2 countries.
Funding
Abstract
objectiveReports of amputations associated with sodium-glucose cotransporter 2 (SGLT2) inhibitors have been inconsistent. We aimed to compare the risk of below-knee amputation with SGLT2 inhibitors versus dipeptidyl peptidase 4 (DPP-4) inhibitors among patients with type 2 diabetes. RESEARCH DESIGN AND
methodsThis multicenter observational study used administrative health care databases from seven Canadian provinces and the U.K. Incident SGLT2 inhibitor users were matched to DPP-4 inhibitor users using a prevalent new-user design and time-conditional propensity scores. Cox proportional hazards models were used to estimate site-specific adjusted hazard ratios (HR) and corresponding 95% CIs of incident below-knee amputation for SGLT2 inhibitor versus DPP-4 inhibitor users. Random effects meta-analyses were used to pool the site-specific results.
resultsThe study cohort included 207,817 incident SGLT2 inhibitor users matched to 207,817 DPP-4 inhibitor users. During a mean exposed follow-up time of 11 months, the amputation rate was 1.3 per 1,000 person-years among SGLT2 inhibitor users and 1.5 per 1,000 person-years among DPP-4 inhibitor users. The adjusted HR of below-knee amputations associated with SGLT2 inhibitor use compared with DPP-4 inhibitor use was 0.88 (95% CI 0.71-1.09). Similar results were obtained in stratified analyses by specific SGLT2 inhibitor molecule.
conclusionsIn this large multicenter observational study, there was no association between SGLT2 inhibitor use and incident below-knee amputations among patients with type 2 diabetes compared with DPP-4 inhibitor use. While these findings provide some reassurance, studies with a longer duration of follow-up are needed to assess potential long-term effects.
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What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.