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.
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
Type 1 diabetes mellitus, or other specified diabetes types that are not type 2 diabetes
Human immunodeficiency virus infection
Bariatric surgery
Solid-organ transplantation
Adults will be selected from the TriNetX US Collaborative Network, a distributed database of de-identified electronic health records contributed by participating healthcare organizations across multiple clinical systems and practice settings. The study population consists of adults with type 2 diabetes who were hospitalized with pneumonia and received routine clinical care in this network, identified through diagnosis records, laboratory data, encounter records, and medication prescribing data. Comparator-specific cohorts were defined within this source population according to glucose-lowering prescriptions recorded in the year before the index admission, to evaluate preadmission GLP-1 receptor agonist- and SGLT2 inhibitor-based treatment strategies.
Cohort
Retrospective
Not listed
Composite outcome (all-cause mortality, invasive mechanical ventilation, or renal replacement therapy)
All-cause mortality
Invasive mechanical ventilation
Renal replacement therapy
Composite outcome (all-cause mortality, major adverse cardiovascular events, or major adverse kidney events)
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Chung Shan Medical University
Lead sponsor
National Science and Technology Council, Taiwan
Collaborator
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