AimsThe cardioprotective effects of glucose-lowering medications in diabetic patients with heart failure (HF) are well known. Several large randomized controlled trials (RCTs) have recently suggested that the cardioprotective effects of glucose-lowering medications extend to HF patients regardless of diabetic status. The aim of this study was to conduct a Bayesian network meta-analysis to evaluate the impact of various glucose-lowering medications on the outcomes of non-diabetic HF patients. Methods and results Medline and Embase were searched for RCTs investigating the use of glucose-lowering medications in non-diabetic HF patients in August 2021. Studies were included in accordance with the inclusion and exclusion criteria, and data were extracted with a pre-defined datasheet. Primary outcomes include serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels, left ventricular ejection fraction (LVEF), and maximal oxygen consumption (PVO 2 ). A Bayesian network meta-analysis was performed to compare the effectiveness of different classes of glucose-lowering medications in improving HF outcomes. Risk-of-bias was assessed using Cochrane Risk-of-Bias tool 2.0 for randomized trials (ROB2). Seven RCTs involving 2897 patients were included. Sodium-glucose transporter 2 inhibitor (SGLT2i) was the most favourable in lowering NT-proBNP, with the significant reduction in NT-proBNP when compared with glucagon-like peptide-1 receptor agonists (GLP1-RA) [mean differences (MD): À229.59 pg/mL, 95%-credible intervals (95%-CrI): À238.31 to À220.91], metformin (MD: À237.15 pg/mL, 95%-CrI: À256.19 to À218.14), and placebo (MD: À228.00 pg/mL, 95%-CrI: À233.99 to À221.99). SGLT2i was more effective in improving LVEF for HF with reduced ejection fraction patients relative to GLP1-RA (MD: 8.09%, 95%-CrI: 6.30 to 9.88) and placebo (MD: 6.10%, 95%-CrI: 4.37 to 7.84). SGLT2i and GLP1-RA were more favourable to placebo in improving PVO 2 , with significant increase of PVO 2 at a MD of 1.60 mL/kg/min (95%-CrI: 0.63 to 2.57) and 0.86 mL/kg/min (95%-CrI: 0.66 to 1.06), respectively. All three drugs had comparable safety profiles when compared with placebo. Conclusions This Bayesian network meta-analysis demonstrated that SGLT2i, when compared with GLP1-RA and metformin, was superior in improving LVEF in HF with reduced ejection fraction patients, as well as improving PVO 2 and NT-proBNP in non-diabetic HF patients. Further large-scale prospective studies are needed to confirm these preliminary findings.
Objective: Metabolic bariatric procedures are potentially efficacious treatment options in patients with type 2 diabetes mellitus (T2DM). Previous meta-analyses focused on individual operative approaches rather than the mechanistic pathways behind different bariatric procedures. This updated network meta-analysis aimed to synthesize new evidence and comparatively evaluate the efficacy of metabolic surgery against restrictive procedures and standard first-line treatment for patients with T2DM.Methods: Embase, MEDLINE, and trial registries were searched for randomized controlled trials on bariatric surgeries in patients with T2DM on September 3, 2021.A Bayesian network meta-analysis was conducted. The primary outcome was T2DM remission. Secondary outcomes included changes in BMI, lipoprotein levels, and blood pressure.Results: Thirty-two articles were included. Metabolic surgery was statistically superior to restrictive procedures (risk ratio [RR]: 2.57, 95% credibility intervals [CrI]:
Background and aims Metabolic bariatric surgeries are potentially efficacious treatment options in patients with type 2 diabetes mellitus (T2DM). However, previous meta-analyses focused on individual operative approaches rather than the mechanistic pathways behind different bariatric procedures. Thus, this updated network meta-analysis aimed to synthesize new evidence and comparatively evaluate the efficacy of bypass against restrictive procedures and standard first-line treatment for patients with T2DM. Methods Embase, Medline and trial registries were searched for randomized controlled trials on bariatric surgeries in patients with T2DM. A Bayesian network meta-analysis was conducted to compare between bypass, restrictive bariatric procedures, medical therapy and lifestyle intervention. Primary outcomes were T2DM remission and improvements in glycated haemoglobin (HbA1c). Secondary outcomes included changes in body mass index (BMI), lipoprotein levels and blood pressure. Results Thirty-two articles comprising 2,071 patients were included. Bypass surgery was statistically superior to restrictive procedures (RR: 2.57, 95% CrI: 1.36 to 5.43), medical therapy (RR: 35.29, 95% Crl: 10.56 to 183.23), and lifestyle intervention (RR: 40.51, 95% Crl: 5.32 to 402.59) in T2DM remission. Both bypass surgery and restrictive procedures were largely comparable in lowering HbA1c (MD: 0.02, 95% Crl: −0.03 to 0.08). In addition, bypass surgery significantly lowered BMI and blood pressure compared to other interventions. While restrictive procedures significantly increased high-density lipoproteins compared to bypass surgery, lifestyle intervention and bypass surgery were statistically superior to restrictive procedures in reducing low-density lipoproteins. Conclusion This study demonstrates that bypass surgery is superior to restrictive bariatric procedures in diabetes remission and glycaemic control. Additionally, significant metabolic advantages support the choice of bypass surgery over restrictive bariatric procedures in T2DM management. Funding Acknowledgement Type of funding sources: None.
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