Metformin vs SGLT2-Inhibitor: Cardiovascular Effects in Diabetes Patients

The MACES study focuses on comparing the effectiveness of two diabetes medications, Metformin and SGLT2-inhibitors, in relation to cardiovascular health. This research targets individuals with diabetes and pre-existing heart conditions, aiming to understand which drug better reduces the risk of heart-related complications. The study takes into account various factors like existing medical conditions, diabetes severity, healthcare usage, prescriber characteristics, and other medications. The potential findings of this study could help improve treatment strategies for diabetic patients with heart disease, ensuring they receive the most effective care. In this observational study, participants are matched based on their likelihood of receiving either Metformin or an SGLT2-inhibitor, taking into account numerous baseline factors. This matching process helps to balance the comparison between the two treatment groups. The study's primary outcome measures the incidence of cardiovascular events, such as stroke, myocardial infarction, and heart failure, using ICD9 and ICD10 codes. These events will only be analyzed individually if there are more than 30 instances of a specific event. The study also conducts sensitivity analyses and may assess the primary risk in patients with a history of cardiovascular disease, if a sufficient sample size is available. To ensure the accuracy of the results, researchers will also conduct a tracer analysis using cellulitis as an outcome, as it is unrelated to both SGLT2s and Metformin.