SGLT-2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors and risk of hyperkalemia among people with type 2 diabetes in clinical practice: population based cohort study.

Fu EL, Wexler DJ, Cromer SJ, Bykov K, Paik JM, Patorno E

BMJ (Clinical research ed.)26 Jun 2024Cited by 26 (Europe PMC)

PMID38925801PMCIDPMC11200155DOI10.1136/bmj-2023-078483PepBankPUB-38925801

Read at source PubMedAsk about this study

Summary

The text of this summary is not shown here, because the article license does not allow reuse. Read it at the source (opens in a new tab)

Text rights: CC BY-NC. Results still quote short attributed sentences.

Results from this study10

2 results from studies that gave the peptide. 2 results from people.

01HumanObservational studyEfficacy outcome
In adults with type 2 diabetes, liraglutide was associated with a lower rate of hyperkalemia than DPP-4 inhibitors.
In plain wordsIn adults with type 2 diabetes, liraglutide was linked to less hyperkalemia than DPP-4 inhibitors.
Peptide
Liraglutide
Outcome
DecreaseHyperkalemia
Study
n: not reported in source
Comparator
DPP-4 inhibitors
Analysis
Primary
Outcome group
Kidney function · Kidney and urinary
Studied dose
Dose not stated
Source sentences
Summary
Compared with DPP-4 inhibitors, the lower rate of hyperkalemia was consistently observed across individual agents in the SGLT-2 inhibitor (canagliflozin, dapagliflozin, empagliflozin) and GLP-1 receptor agonist (dulaglutide, exenatide, liraglutide, semaglutide) classes.
1 context sentence(design, population, supporting numbers)
Summary · context
Population based cohort study with active-comparator, new user design.
Report a problemFND-3892580105
02HumanObservational studyEfficacy outcome
In adults with type 2 diabetes, semaglutide was associated with a lower rate of hyperkalemia than DPP-4 inhibitors.
In plain wordsIn adults with type 2 diabetes, semaglutide was linked to less hyperkalemia than DPP-4 inhibitors.
Peptide
Semaglutide
Outcome
DecreaseHyperkalemia
Study
n: not reported in source
Comparator
DPP-4 inhibitors
Analysis
Primary
Outcome group
Kidney function · Kidney and urinary
Studied dose
Dose not stated
Source sentences
Summary
Compared with DPP-4 inhibitors, the lower rate of hyperkalemia was consistently observed across individual agents in the SGLT-2 inhibitor (canagliflozin, dapagliflozin, empagliflozin) and GLP-1 receptor agonist (dulaglutide, exenatide, liraglutide, semaglutide) classes.
1 context sentence(design, population, supporting numbers)
Summary · context
Population based cohort study with active-comparator, new user design.
Report a problemFND-3892580110

Studies that did not test the peptide alone8

In this study, the peptide was a lab tool or a carrier, part of a mix, or the subject of a lab method. These results are not evidence about taking the peptide.

03HumanNot a test of Liraglutide aloneObservational studyEfficacy outcome
In adults with type 2 diabetes, hyperkalemia occurred at a slightly higher rate with pooled GLP-1 receptor agonists than with SGLT-2 inhibitors (hazard ratio 0.92 for SGLT-2 inhibitors; absolute risk 4.7% v 6.0%).
In plain wordsIn adults with type 2 diabetes, GLP-1 drugs as a group were linked to slightly more hyperkalemia than SGLT-2 inhibitors.
Peptide
Liraglutide
Outcome
IncreaseHyperkalemia, GLP-1RA versus SGLT-2 inhibitors
Study
n = 873,460
Comparator
SGLT-2 inhibitors
Analysis
Primary
Outcome group
Kidney function · Kidney and urinary
Measurements
HR
0.92
SGLT-2i vs GLP-1RA
Source sentences
Summary
a slight reduction in rate compared with GLP-1 receptor agonists (0.92, 0.89 to 0.95).
2 context sentences(design, population, supporting numbers)
Summary · context
1.2% (0.9% to 1.5%) lower for SGLT-2 inhibitors than GLP-1 receptor agonists (4.7% v 6.0%).
Summary · context
Population based cohort study with active-comparator, new user design.
In this study, Liraglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Liraglutide.
Report a problemFND-3892580103
04HumanNot a test of Semaglutide aloneObservational studyEfficacy outcome
In adults with type 2 diabetes, hyperkalemia occurred at a slightly higher rate with pooled GLP-1 receptor agonists than with SGLT-2 inhibitors (hazard ratio 0.92 for SGLT-2 inhibitors; absolute risk 4.7% v 6.0%).
In plain wordsIn adults with type 2 diabetes, GLP-1 drugs as a group were linked to slightly more hyperkalemia than SGLT-2 inhibitors.
Peptide
Semaglutide
Outcome
IncreaseHyperkalemia, GLP-1RA versus SGLT-2 inhibitors
Study
n = 873,460
Comparator
SGLT-2 inhibitors
Analysis
Primary
Outcome group
Kidney function · Kidney and urinary
Measurements
HR
0.92
SGLT-2i vs GLP-1RA
Source sentences
Summary
a slight reduction in rate compared with GLP-1 receptor agonists (0.92, 0.89 to 0.95).
2 context sentences(design, population, supporting numbers)
Summary · context
1.2% (0.9% to 1.5%) lower for SGLT-2 inhibitors than GLP-1 receptor agonists (4.7% v 6.0%).
Summary · context
Population based cohort study with active-comparator, new user design.
In this study, Semaglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Semaglutide.
Report a problemFND-3892580108
05HumanNot a test of Liraglutide aloneObservational studyEfficacy outcome
In adults with type 2 diabetes, pooled GLP-1 receptor agonists were associated with a lower rate of hyperkalemia than DPP-4 inhibitors (hazard ratio 0.79).
In plain wordsIn adults with type 2 diabetes, GLP-1 drugs as a group were linked to less hyperkalemia than DPP-4 inhibitors.
Peptide
Liraglutide
Outcome
DecreaseHyperkalemia
Study
n = 729,820
Comparator
DPP-4 inhibitors
Analysis
Primary
Outcome group
Kidney function · Kidney and urinary
Measurements
HR
0.79
GLP-1RA vs DPP-4i
Source sentences
Summary
Use of GLP-1 receptor agonists was associated with a lower rate of hyperkalemia than DPP-4 inhibitors (0.79, 0.77 to 0.82).
1 context sentence(design, population, supporting numbers)
Summary · context
Population based cohort study with active-comparator, new user design.
In this study, Liraglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Liraglutide.
Report a problemFND-3892580101
06HumanNot a test of Liraglutide aloneObservational studyEfficacy outcome
In adults with type 2 diabetes, the three year absolute risk of hyperkalemia was 1.8% lower for pooled GLP-1 receptor agonists than for DPP-4 inhibitors (5.7% v 7.5%).
In plain wordsIn adults with type 2 diabetes, GLP-1 drugs as a group were linked to 1.8% lower three-year hyperkalemia risk than DPP-4 inhibitors.
Peptide
Liraglutide
Outcome
DecreaseThree-year absolute risk of hyperkalemia
Study
n = 729,820
Comparator
DPP-4 inhibitors
Analysis
Primary
Outcome group
Kidney function · Kidney and urinary
Measurements
Absolute risk difference
1.8%
GLP-1RA vs DPP-4i
Source sentences
Summary
1.8% (1.4% to 2.1%) lower for GLP-1 receptor agonists than DPP-4 inhibitors (5.7% v 7.5%)
1 context sentence(design, population, supporting numbers)
Summary · context
Population based cohort study with active-comparator, new user design.
In this study, Liraglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Liraglutide.
Report a problemFND-3892580102
07HumanNot a test of Semaglutide aloneObservational studyEfficacy outcome
In adults with type 2 diabetes, pooled GLP-1 receptor agonists were associated with a lower rate of hyperkalemia than DPP-4 inhibitors (hazard ratio 0.79).
In plain wordsIn adults with type 2 diabetes, GLP-1 drugs as a group were linked to less hyperkalemia than DPP-4 inhibitors.
Peptide
Semaglutide
Outcome
DecreaseHyperkalemia
Study
n = 729,820
Comparator
DPP-4 inhibitors
Analysis
Primary
Outcome group
Kidney function · Kidney and urinary
Measurements
HR
0.79
GLP-1RA vs DPP-4i
Source sentences
Summary
Use of GLP-1 receptor agonists was associated with a lower rate of hyperkalemia than DPP-4 inhibitors (0.79, 0.77 to 0.82).
1 context sentence(design, population, supporting numbers)
Summary · context
Population based cohort study with active-comparator, new user design.
In this study, Semaglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Semaglutide.
Report a problemFND-3892580106
08HumanNot a test of Semaglutide aloneObservational studyEfficacy outcome
In adults with type 2 diabetes, the three year absolute risk of hyperkalemia was 1.8% lower for pooled GLP-1 receptor agonists than for DPP-4 inhibitors (5.7% v 7.5%).
In plain wordsIn adults with type 2 diabetes, GLP-1 drugs as a group were linked to 1.8% lower three-year hyperkalemia risk than DPP-4 inhibitors.
Peptide
Semaglutide
Outcome
DecreaseThree-year absolute risk of hyperkalemia
Study
n = 729,820
Comparator
DPP-4 inhibitors
Analysis
Primary
Outcome group
Kidney function · Kidney and urinary
Measurements
Absolute risk difference
1.8%
GLP-1RA vs DPP-4i
Source sentences
Summary
1.8% (1.4% to 2.1%) lower for GLP-1 receptor agonists than DPP-4 inhibitors (5.7% v 7.5%)
1 context sentence(design, population, supporting numbers)
Summary · context
Population based cohort study with active-comparator, new user design.
In this study, Semaglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Semaglutide.
Report a problemFND-3892580107
09HumanNot a test of Liraglutide aloneObservational studyEfficacy outcome
In adults with type 2 diabetes, the absolute-scale benefit of pooled GLP-1 receptor agonists on hyperkalemia was largest in people with heart failure, chronic kidney disease or mineralocorticoid receptor antagonist use.
In plain wordsIn adults with type 2 diabetes, GLP-1 drugs as a group were linked to the largest hyperkalemia benefit with heart failure or kidney disease.
Peptide
Liraglutide
Outcome
DecreaseHyperkalemia in subgroups with heart failure, chronic kidney disease or MRA use
Study
n: not reported in source
Comparator
DPP-4 inhibitors
Outcome group
Kidney function · Kidney and urinary
Source sentences
Summary
Benefits for SGLT-2 inhibitors and GLP-1 receptor agonists on the absolute scale were largest for those with heart failure, chronic kidney disease, or those using mineralocorticoid receptor antagonists.
1 context sentence(design, population, supporting numbers)
Summary · context
Population based cohort study with active-comparator, new user design.
In this study, Liraglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Liraglutide.
Report a problemFND-3892580104
10HumanNot a test of Semaglutide aloneObservational studyEfficacy outcome
In adults with type 2 diabetes, the absolute-scale benefit of pooled GLP-1 receptor agonists on hyperkalemia was largest in people with heart failure, chronic kidney disease or mineralocorticoid receptor antagonist use.
In plain wordsIn adults with type 2 diabetes, GLP-1 drugs as a group were linked to the largest hyperkalemia benefit with heart failure or kidney disease.
Peptide
Semaglutide
Outcome
DecreaseHyperkalemia in subgroups with heart failure, chronic kidney disease or MRA use
Study
n: not reported in source
Comparator
DPP-4 inhibitors
Outcome group
Kidney function · Kidney and urinary
Source sentences
Summary
Benefits for SGLT-2 inhibitors and GLP-1 receptor agonists on the absolute scale were largest for those with heart failure, chronic kidney disease, or those using mineralocorticoid receptor antagonists.
1 context sentence(design, population, supporting numbers)
Summary · context
Population based cohort study with active-comparator, new user design.
In this study, Semaglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Semaglutide.
Report a problemFND-3892580109

AI wrote and checked these results. AI can make mistakes, so check important results against the source.

Version history

PepBank keeps every version of the data on this study. Status changes from Retraction Watch, Europe PMC and Crossref are listed with their source.

Version 3Current
12 Oct 2026, 11:11 UTC
Study results updated
Version 2
9 Oct 2026, 03:06 UTC
Study data updated · source update from Europe PMC
Version 1
9 Oct 2026, 03:05 UTC
First added · source update from Europe PMC

SGLT-2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors and risk of hyperkalemia among people with type 2 diabetes in clinical practice: population based cohort study.

Summary

Results from this study10

Studies that did not test the peptide alone8

Version history

Subjects

Publication types

MeSH terms