Objective This study aimed to compare the risk of suicide in patients with Type 2 Diabetes Mellitus (T2DM) treated with glucagon-like peptide-1 receptor agonists (GLP-1RA) versus sodium glucose cotransporter-2 inhibitors (SGLT-2i).

Methods We conducted a retrospective cohort study from December 2013 to December 2022 at ajou university hospital, utilizing the Observational Medical Outcomes Partnership Common Data Model. We defined four cohorts comprising adult patients with T2DM who initiated either GLP-1RA or SGLT-2i treatment. The outcome was a composite of mental disorders, including depression, dysthymia, mood disorders, suicide attempts, and antidepressant usage. Patients were matched in a 1:1 ratio by propensity-score for GLP-1RA vs SGLT-2i. Cox proportional hazard models were employed to estimate hazard ratios (HR) and 95% confidence intervals (CIs).

Results We identified a total of 974 patients with T2DM who initiated either GLP-1RA or SGLT-2i. Among patients with T2DM, GLP-1RA did not demonstrate a higher incidence of mental disorders (HR, 1.33; 95% CI 0.56-3.27). In patients without a history of depression, suicide attempts, mood disorders, or antidepressant use, GLP-1RA use was not associated with increase in mental health outcomes (HR, 1.27; 95% CI 0.58-2.87).

Conclusion Our study found no significant difference in the risk of suicide in patients with T2DM, and the initiation of GLP-1RA was not associated with an increased incidence of mental health disorders.