Patients with type 2 diabetes initiated on an SGLT2 inhibitor are at no more risk of an amputation below the knee than those taking a DPP-4 inhibitor, at least in the first year, a real-world study suggests.

In the largest observational study on the topic to date, researchers compared records from 208,000 patients with type 2 diabetes in Canadian and UK databases who were prescribed an SGLT2 inhibitor with the same number of matched patients on a DPP-4 inhibitor.

Over a mean exposure to the drugs of 11 months, the amputation rate was 1.3 per 1000 person-years for those on SGLT2 inhibitors vs 1.5 per 1000 person-years in those taking DPP-4 inhibitors — a difference that was not statistically significant, the Canadian authors reported in Diabetes Care.

“With data from eight databases across two countries, our study is the largest observational study conducted examining this safety issue to date, increasing the precision and generalisability of our results,” they said.