The American journal of medicine
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Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel class of medications that reduce plasma glucose concentrations through an insulin-independent mechanism of increased urinary glucose excretion, with concomitant natriuresis and diuresis. Clinical outcomes trials with SGLT2 inhibitors revealed a cardioprotective benefit among patients with diabetes mellitus, with a consistent reduction in hospitalization for heart failure. ⋯ Although well tolerated, there are known adverse effects with SGLT2 inhibitors that require clinical monitoring, such as genital mycotic infections, diabetic ketoacidosis, volume depletion particularly in the setting of concomitant diuretic use, and lower limb amputations with canagliflozin. Ongoing clinical trials will uncover the potential benefit of SGLT2 inhibitors in patients with prevalent heart failure with or without diabetes mellitus.
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Review
Propensity Score Matching: The 'Devil is in the Details' Where More May Be Hidden than You Know.
Propensity score matching has been used with increasing frequency in the analyses of non-prespecified subgroups of randomized clinical trials, and in retrospective analyses of clinical trial data sets, registries, observational studies, electronic medical record analyses, and more. The method attempts to adjust post hoc for recognized unbalanced factors at baseline such that the data once analyzed will hopefully approximate or indicate what a prospective randomized data set-the "gold standard" for comparing two or more therapies-would have shown. ⋯ Thus, propensity score matching analyses may omit, due to nonrecognition, the effects of several clinically important but not considered factors that can affect the outcomes of the analyses being reported, causing them to possibly be misleading, or hypothesis-generating at best. This review discusses this issue, using several specific examples, and is targeted at clinicians to make them aware of the limitations of such analyses when they apply their results to patients in their care.