Body weight significantly decreased in patients with type 2 diabetes who received different dosages of SGLT2 inhibitors compared with patients who received a placebo. Moreover, in patients treated with dapagliflozin, there was a statistically significant dosage-dependent trend in body weight reduction.

Highlights• This meta-analysis found that metformin use was associated with a significantly increased risk of vitamin B 12 deficiency and significantly lower serum vitamin B 12 concentrations in a dose-and duration-dependent manner in patients with diabetes. • The meta-analysis did not find significant associations between metformin use and the risk of anemia or neuropathy in patients with diabetes. • Annual vitamin B 12 assessment in diabetic patients taking metformin is recommended, and appropriate preventative and therapeutic measures should be taken when necessary. AbstractBackground: Metformin is first-line therapy for patients with diabetes. However, it may lower vitamin B 12 concentrations, which could have hematological or neurological implications. This meta-analyses reviewed all available studies on associations between metformin use and vitamin B 12 levels, anemia, and neuropathy in diabetic patients. Methods: PubMed, Web of Knowledge, Cochrane Library, and Embase were searched to identify all relevant studies published in English prior to March 2018. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for dichotomous outcomes and pooled mean differences (MDs) and 95% CIs were calculated for continuous outcomes.Results: Thirty-one studies were included in the meta-analyses. Compared with diabetic patients not taking metformin, patients taking metformin had a significantly higher risk of vitamin B 12 deficiency (RR 2.09; 95% CI 1.49, 2.93; P < 0.0001; I 2 = 64%) and significantly lower serum vitamin B 12 concentrations (MD −63.70; 95% CI −74.35, −53.05] pM; P < 0.00001; I 2 = 87%), which depended on dose and duration of treatment. Metformin use was also associated with significantly greater percentage decrease in serum vitamin B 12 concentrations from baseline in diabetic patients (MD −14.68%; 95% CI −17.98%, −11.39%; P < 0.00001; I 2 = 33%). Analyses revealed no significant association between metformin use and the prevalence of anemia or neuropathy.Conclusions: Metformin use led to significantly lowered vitamin B 12 concentrations and significantly higher risk of vitamin B 12 deficiency in diabetic patients. More quality studies are needed to explore the associations between metformin use

Background To evaluate the risk of infections in the treatment of type 2 diabetes patients with dipeptidyl-peptidase 4 (DPP-4) inhibitors.

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Aims/IntroductionTo evaluate whether there is disparity of the efficacy and all‐cause mortality and other adverse effects between Asian and non‐Asian patients with sodium–glucose cotransporter 2 (SGLT2) inhibitors treatment.Materials and MethodsRandomized clinical trials publicly available before January 2017, comparing SGLT2 inhibitors treatment with a placebo in type 2 diabetes patients were identified. The association between treatment and outcomes was estimated by computing the weighted mean difference for glycated hemoglobin level, blood pressure level, lipid profile levels and bodyweight, and the odds ratios for adverse events.ResultsA total of 17 trials with Asian patients were included and 39 trials with non‐Asian patients were included. Comparison of the glycated hemoglobin decreases corrected by a placebo between Asian and non‐Asian patients showed that there was a non‐significant difference of 0.05% between groups (P > 0.05). Comparisons of the bodyweight changes and blood pressure changes corrected by a placebo between Asian and non‐Asian patients did not show a significant difference between groups (P > 0.05). The risk of all‐cause mortality was not increased when compared with a placebo both in Asian and non‐Asian populations, and the risk of genital infection in Asian and non‐Asian populations were both significant increased.ConclusionsOverall, according to the present meta‐analysis, comparison of the efficacy in SGLT2 inhibitors treatment between Asian and non‐Asian type 2 diabetes patients showed no significant difference in glycated hemoglobin reduction and bodyweight reduction. Furthermore, no disparity was found in the risk of all‐cause mortality or hypoglycemia in SGLT2 inhibitors treatment between Asian and non‐Asian patients.

Compare with non-smokers, the risk of diabetic retinopathy significantly increased in smokers with type 1 diabetes while significantly decreased in smokers with type 2 diabetes. However, this result did not change the importance of smoking cessation for public health.

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Aims/IntroductionTo evaluate the efficacy of weight changes from baseline of the sodium‐glucose cotransporter 2 (SGLT2) inhibitors treatment and glucagon‐like peptide‐1 (GLP‐1) analogs treatment after comparisons with a placebo in type 2 diabetes patients, and the associated factors.Materials and MethodsStudies were searched from when recording began, June 2004, until June 2015, and re‐searched in July 2016, and placebo‐controlled randomized trials in type 2 diabetes patients with a study length of ≥12 weeks were included.ResultsA total of 97 randomized controlled trials were included. Compared with a placebo, treatment with SGLT2 inhibitors was associated with a significantly greater decrease in weight change from baseline (weighted mean differences −2.01 kg, 95% confidence interval −2.18 to −1.83 kg, P < 0.001). Compared with a placebo, changes with GLP ‐1 treatment were also associated with a comparable decrease in weight change from baseline (weighted mean differences −1.59 kg, 95% confidence interval −1.86 to −1.32 kg, P < 0.001). Meta‐regression analysis showed that the baseline age, sex, baseline glycated hemoglobin, diabetes duration or baseline body mass index were not associated with the weight change from baseline in SGLT2 inhibitors or in GLP‐1 treatment corrected by placebo. Comparisons of weight changes from baseline corrected by placebo between SGLT2 inhibitors and GLP‐1 treatment showed that the difference was not significant (P > 0.05).ConclusionsAccording to the present meta‐analysis, treatment with SGLT2 inhibitors and treatment with GLP‐1 analogs led to comparable weight changes from baseline, which are both with significance when compared with placebo treatment.