Assessing Diabetic Foot Disease Risk With SGLT-2 Inhibitors

Background: Diabetic foot disease, including neuropathy, peripheral artery disease (PAD), ulcers, and lower-limb amputation, is a major complication of type 2 diabetes. sodium–glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) improve glycemic, cardiometabolic, and cardiorenal outcomes, but their comparative effects on diabetic foot outcomes remain uncertain. Concern about SGLT-2is followed by the CANVAS (Canagliflozin Cardiovascular Assessment Study) signal for increased amputation risk with canagliflozin, although this was not reproduced in the CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) trial. Objective: To compare the risk of diabetic foot disease among new users of SGLT-2is versus GLP-1RAs in adults with type 2 diabetes. Design: Danish population-based cohort study using target trial emulation. Participants: Adults with type 2 diabetes initiating SGLT-2i or GLP-1R more...