Lowering of hemoglobin A1C and risk of cardiovascular outcomes and all-cause mortality, a meta-regression analysis.
Cardiovascular Diseases
/ epidemiology
Diabetes Mellitus, Type 2
/ complications
Dipeptidyl-Peptidase IV Inhibitors
/ therapeutic use
Glycated Hemoglobin
/ metabolism
Humans
Hypoglycemic Agents
/ therapeutic use
Middle Aged
Mortality
Randomized Controlled Trials as Topic
Regression Analysis
Sodium-Glucose Transporter 2 Inhibitors
/ therapeutic use
Antihyperglycemic medications
Cardiovascular outcome
Complications
Diabetes
Mortality
Pharmacotherapy
Journal
Journal of diabetes and its complications
ISSN: 1873-460X
Titre abrégé: J Diabetes Complications
Pays: United States
ID NLM: 9204583
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
20
05
2020
revised:
13
07
2020
accepted:
25
07
2020
pubmed:
6
9
2020
medline:
25
11
2021
entrez:
5
9
2020
Statut:
ppublish
Résumé
The management of type 2 diabetes predominantly focuses on reducing hemoglobin A1C (HbA1c). We examined the association between the magnitude of reduction in HbA1c and cardiovascular outcomes for new diabetes medications: sodium-glucose cotransporter-2 [SGLT2] inhibitors, glucagon-like peptide-1 [GLP1] agonists, and dipeptidyl peptidase-4 [DPP4] inhibitors. We reviewed all published, placebo-controlled, randomized cardiovascular outcome trials. Meta-regression was performed to evaluate the association between HbA1c reduction (i.e., [post-intervention HbA1c for active drug - pre-intervention HbA1c for active drug] - [post-intervention HbA1c for placebo - pre-intervention HbA1c for placebo]) and the composite cardiovascular outcome (i.e., stroke, myocardial infarction, or cardiovascular death). We identified 14 cardiovascular outcome clinical trials, the median sample size was 9401, the median age was 64 years, the median time since diagnosis of diabetes was 12 years, and the median duration of trial follow-up was 120 weeks. Within individual medication classes, each additional 0.5% reduction in HbA1c in the active drug arm, relative to placebo, was associated with a lower incidence of cardiovascular events for GLP1 agonists (0.82, 0.68-0.98) but not for SGLT2 (0.97, 0.69-1.36) or DPP4 (1.03, 0.39-2.74) inhibitors. Our study provides further support that reducing the risk of cardiovascular events for adults with diabetes is partly explained by a reduction in HbA1c.
Sections du résumé
BACKGROUND
The management of type 2 diabetes predominantly focuses on reducing hemoglobin A1C (HbA1c). We examined the association between the magnitude of reduction in HbA1c and cardiovascular outcomes for new diabetes medications: sodium-glucose cotransporter-2 [SGLT2] inhibitors, glucagon-like peptide-1 [GLP1] agonists, and dipeptidyl peptidase-4 [DPP4] inhibitors.
METHODS
We reviewed all published, placebo-controlled, randomized cardiovascular outcome trials. Meta-regression was performed to evaluate the association between HbA1c reduction (i.e., [post-intervention HbA1c for active drug - pre-intervention HbA1c for active drug] - [post-intervention HbA1c for placebo - pre-intervention HbA1c for placebo]) and the composite cardiovascular outcome (i.e., stroke, myocardial infarction, or cardiovascular death).
RESULTS
We identified 14 cardiovascular outcome clinical trials, the median sample size was 9401, the median age was 64 years, the median time since diagnosis of diabetes was 12 years, and the median duration of trial follow-up was 120 weeks. Within individual medication classes, each additional 0.5% reduction in HbA1c in the active drug arm, relative to placebo, was associated with a lower incidence of cardiovascular events for GLP1 agonists (0.82, 0.68-0.98) but not for SGLT2 (0.97, 0.69-1.36) or DPP4 (1.03, 0.39-2.74) inhibitors.
DISCUSSION
Our study provides further support that reducing the risk of cardiovascular events for adults with diabetes is partly explained by a reduction in HbA1c.
Identifiants
pubmed: 32888788
pii: S1056-8727(20)30472-4
doi: 10.1016/j.jdiacomp.2020.107704
pii:
doi:
Substances chimiques
Dipeptidyl-Peptidase IV Inhibitors
0
Glycated Hemoglobin A
0
Hypoglycemic Agents
0
Sodium-Glucose Transporter 2 Inhibitors
0
Types de publication
Journal Article
Meta-Analysis
Langues
eng
Sous-ensembles de citation
IM
Pagination
107704Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.