AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Sodium-Glucose Cotransporter-2 Inhibitor Therapy and Limb-Related and Mortality Outcomes in Patients with Peripheral Artery Disease and Diabetes Mellitus
By Alnees M, Abu Hamdeh N, Masu'd M et al.
Background: Patients with peripheral artery disease and type 2 diabetes mellitus remain at high risk for major adverse limb events, amputation, and death. The association between sodium-glucose cotransporter-2 (SGLT2) inhibitor therapy and limb-related outcomes in this high-risk population remains incompletely defined. Methods: This retrospective observational cohort study used electronic health record data from a large integrated healthcare system to compare SGLT2 inhibitor users with Glucomin-only users among patients with peripheral artery disease and diabetes mellitus from 2015 onward. Trimmed inverse probability of treatment weighting based on propensity scores was used to balance baseline demographic, clinical, laboratory, comorbidity, and medication characteristics; outcomes included major adverse limb events, limb revascularization, major and minor amputation, and all-cause mortality. Results: A total of 9,428 patients with peripheral artery disease and diabetes mellitus were included, including 3,370 Glucomin-only users and 6,058 SGLT2 inhibitor users before weighting. After trimmed inverse probability of treatment weighting, SGLT2 inhibitor therapy was associated with lower risks of major adverse limb events (HR, 0.76; 95% CI, 0.59-0.97; P=0.030), major amputation (HR, 0.61; 95% CI, 0.41-0.90; P=0.012), and all-cause mortality (HR, 0.45; 95% CI, 0.40-0.50; P<0.001) compared with Glucomin-only therapy. No significant association was observed for limb revascularization (HR, 0.82; 95% CI, 0.60-1.13; P=0.234). Although minor amputation risk was borderline increased (HR, 2.06; 95% CI, 1.00-4.26; P=0.050), this finding was not consistent across sensitivity analyses. Conclusion: In patients with peripheral artery disease and diabetes mellitus, SGLT2 inhibitor therapy was associated with improved limb-related and survival outcomes, supporting its potential role in comprehensive vascular risk management.