Patients with type 2 diabetes mellitus (T2DM) undergoing peripheral artery revascularization remain at high risk for limb and cardiovascular events. A nationwide comparative effectiveness study published in Diabetes Research and Clinical Practice found that treatment with thiazolidinediones (TZD) or sodium-glucose co-transporter-2 inhibitors (SGLT2i) was associated with more favorable clinical outcomes than dipeptidyl peptidase-4 inhibitors (DPP-4i).

The analysis used the Korean National Health Insurance Claims database from 2015 to 2023 and identified patients with T2DM who underwent endovascular or surgical peripheral artery revascularization. A 1:3 propensity score matching method was applied to compare TZD with DPP-4i users and SGLT2i with DPP-4i users.

The primary outcome was a composite of major adverse limb events, stroke, myocardial infarction, admission for heart failure, and all-cause death. Major adverse limb events were defined as repeated revascularization or amputation. The primary outcome occurred in 49.2% of TZD users and 55.5% of DPP-4i users (HR 0.74; 95% CI 0.63-0.86; P < 0.001). It occurred in 39.7% of SGLT2i users and 52.2% of DPP-4i users (HR 0.88; 95% CI 0.79-0.98; P = 0.015).

For secondary outcomes, TZD use was associated with lower risks of major adverse limb events and all-cause death compared with DPP-4i use. SGLT2i treatment was associated with reduced all-cause death compared with DPP-4i use.

These findings suggest that TZD and SGLT2i were associated with favorable clinical outcomes compared with DPP-4i in patients with T2DM undergoing peripheral artery revascularization.