Effects of glucose-lowering agents on cardiovascular and renal outcomes in subjects with type 2 diabetes: An updated meta-analysis of randomized controlled trials with external adjudication of events.
Adult
Humans
Diabetes Mellitus, Type 2
/ complications
Hypoglycemic Agents
/ adverse effects
Glucose
/ therapeutic use
Pioglitazone
/ therapeutic use
Glucagon-Like Peptide-1 Receptor
/ agonists
Albuminuria
/ drug therapy
Creatinine
Randomized Controlled Trials as Topic
Sodium-Glucose Transporter 2 Inhibitors
/ therapeutic use
Metformin
/ therapeutic use
Heart Failure
/ complications
Cardiovascular Diseases
/ epidemiology
all-cause mortality
glucose-lowering agents
major cardiovascular adverse events
meta-analysis
renal adverse outcomes
Journal
Diabetes, obesity & metabolism
ISSN: 1463-1326
Titre abrégé: Diabetes Obes Metab
Pays: England
ID NLM: 100883645
Informations de publication
Date de publication:
02 2023
02 2023
Historique:
revised:
29
09
2022
received:
29
06
2022
accepted:
04
10
2022
pubmed:
8
10
2022
medline:
5
1
2023
entrez:
7
10
2022
Statut:
ppublish
Résumé
To investigate the effects of glucose-lowering agents on all-cause mortality, and cardiovascular and renal outcomes in adults with type 2 diabetes. A MEDLINE and EMBASE search was performed to identify randomized controlled trials, published up to 28 February 2022, with a follow-up ≥52 weeks, in which glucose-lowering drugs were compared with either placebo or active comparators. We included only trials reporting formal external adjudication of events. All-cause mortality, 3-point MACE (major cardiovascular events), and hospitalization for heart failure (HHF) were considered as principal outcomes. Doubling of serum creatinine, worsening albuminuria, and renal death were considered as secondary endpoints. We included randomized controlled trials performed on metformin (n = 17), pioglitazone (n = 20), alpha-glucosidase inhibitors (n = 9), insulin secretagogues (n = 42), dipeptidyl-peptidase-4 inhibitors (n = 67), glucagon-like peptide-1 receptor agonists (n = 45) or sodium-glucose co-transporter-2 inhibitors (SGLT-2i; n = 42) and insulin (n = 18). Glucagon-like peptide-1 receptor agonist and SGLT-2i were associated with a significant reduction in all-cause mortality [Mantel-Haenszel odds ratio (MH-OR), 95% confidence interval: 0.88 (0.83; 0.95) and 0.85 (0.79; 0.91), respectively] and MACE [MH-OR, 95% confidence interval: 0.89 (0.84; 0.94) and 0.90 (0.84; 0.96), respectively]. SGLT-2i was associated with a reduced risk of HHF [MH-OR 0.68 (0.62; 0.75)], worsening albuminuria [MH-OR 0.67 (0.55; 0.80)] and doubling of serum creatinine [MH-OR 0.58 (0.44; 0.79)]. Metformin and pioglitazone were associated with a significantly lower risk of MACE [MH-OR 0.60 (0.47; 0.80) and 0.85 (0.74; 0.97), respectively] and pioglitazone with a higher risk of HHF [MH-OR 1.30 (1.04; 1.62)]. Insulin secretagogues were associated with increased risk of all-cause mortality [MH-OR 1.12 (1.01; 1.24)] and MACE [MH-OR 1.19 (1.02; 1.39)]. The results of this updated meta-analysis need to be considered in the choice of drug treatment for type 2 diabetes mellitus, which cannot be merely based on the effect of glucose-lowering drugs on long-term glycaemic control.
Substances chimiques
Hypoglycemic Agents
0
Glucose
IY9XDZ35W2
Pioglitazone
X4OV71U42S
Glucagon-Like Peptide-1 Receptor
0
Creatinine
AYI8EX34EU
Sodium-Glucose Transporter 2 Inhibitors
0
Metformin
9100L32L2N
Types de publication
Meta-Analysis
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
444-453Informations de copyright
© 2022 John Wiley & Sons Ltd.
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