This retrospective observational target-trial emulation uses electronic health record data from the TriNetX US Collaborative Network to compare preadmission glucose-lowering treatment strategies in adults with type 2 diabetes hospitalized with pneumonia. Time zero is the date of the index pneumonia admission. The study compares patients with evidence of prescriptions for both a GLP-1 receptor agonist and an SGLT2 inhibitor in the year before admission with patients prescribed a GLP-1 receptor agonist alone, an SGLT2 inhibitor alone, or usual care. Usual care includes metformin, sulfonylureas, or DPP-4 inhibitors without either study class. The primary outcome is a composite of all-cause death, invasive mechanical ventilation, or renal replacement therapy within 30 days of admission, with the individual components and 12-month mortality, major adverse cardiovascular events, and major adverse kidney events also evaluated. Propensity-score methods are used to reduce bias from nonrandom treatment selection.
Eligibility
Sex
ALL
Min age
18 Years
Max age
—
Healthy volunteers
No
Inclusion Criteria:
* Adults aged 18 years or older.
* Type 2 diabetes mellitus
* Hospitalization with pneumonia during the study period, serving as the index admission
* Prescription of a GLP-1 receptor agonist, an SGLT2 inhibitor, or usual-care glucose-lowering therapy in the year before the index admission
* No GLP-1 receptor agonist or SGLT2 inhibitor prescription in the 6 months before the first qualifying prescription
Exclusion Criteria:
* Type 1 diabetes mellitus, or other specified diabetes types that are not type 2 diabetes
* Human immunodeficiency virus infection
* Bariatric surgery
* Solid-organ transplantation
* Pneumonia hospitalization, invasive mechanical ventilation, or renal replacement therapy in the year before the index admission
* End-stage kidney disease, dialysis dependence, ventilator dependence, or tracheostomy status
* Metastatic malignancy, lung cancer, or palliative care
* Viral pneumonia, influenza with pneumonia, or COVID-19 around the index admission
* Acute cardiovascular event in the 6 months before the index admission
Primary outcome measure(s)
Composite outcome (all-cause mortality, invasive mechanical ventilation, or renal replacement therapy) — Within 30 days after the index pneumonia admission
Trial sites (1)
Facility
City
Region
Status
Chung Shan Medical University Hospital
Taichung
Taichung
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This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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