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What is already known on this topic Hyperkalemia is associated with increased mortality and limits the use of guideline recommended drugs such as renin-angiotensin system inhibitors among people with type 2 diabetes Sodium-glucose cotransporter-2 (SGLT-2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase-4 (DPP-4) inhibitors are increasingly being used in the treatment of type 2 diabetes The comparative effectiveness of these drugs in preventing hyperkalemia in routine clinical practice is unclear What this study adds In this population based cohort study of people with type 2 diabetes in the United States, starting SGLT-2 inhibitors or GLP-1 receptor agonists was associated with a lower risk of hyperkalemia compared with DPP-4 inhibitors Benefits were consistent among demographic and clinical subgroups, and among single agents within the SGLT-2 inhibitor and GLP-1 receptor agonist classes In addition to improving cardiovascular and kidney outcomes, the potential benefit of preventing hyperkalemia further solidifies the use of SGLT-2 inhibitors and GLP-1 receptor agonists in people with type 2 diabetes Ethics statements Ethical approval This study was approved by the Mass General Brigham institutional review board and granted waiver of informed consent since only deidentified claims data were used

The placebo effect alone can account for significant self-reported improvements in appetite and cravings

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