Comparing SGLT-2 inhibitors to DPP-4 inhibitors as an add-on therapy to metformin in patients with type 2 diabetes: A systematic review and meta-analysis

Mishriky, Basem M.; Tanenberg, Robert J.; Sewell, Kerry; Cummings, Doyle M.

doi:10.1016/j.diabet.2018.01.017

Cited by 39 publications

(28 citation statements)

References 32 publications

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“…The reduction of body weight was observed in the dapagliflozin group since 4 weeks of treatment and was sustained throughout 6 months, which was consistent with previous studies . The rapid change of body weight within the 1 st month of therapy was possibly due to the effect of SGLT2 inhibitor therapy on the plasma volume reduction in the early phase .…”

Section: Discussionsupporting

confidence: 90%

Effects of dapagliflozin vs vildagliptin on cardiometabolic parameters in diabetic patients with coronary artery disease: a randomised study

Phrommintikul

Wongcharoen

Kumfu

et al. 2019

Brit J Clinical Pharma

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Aims: Sodium glucose co-transporter-2 inhibitors have been shown to reduce cardiovascular events and heart failure in type 2 diabetic (T2D) patients with high cardiovascular risk. Dipeptidyl peptidase-4 inhibitors showed neutral effects and may increase risk of heart failure. We aimed to compare cardiometabolic effects of dapagliflozin and vildagliptin in T2D patients with coronary artery disease (CAD).Methods: Forty-nine T2D patients with CAD were randomly assigned to dapagliflozin (n = 25) or vildagliptin (n = 24) for 6 months in a double-blind fashion. Cardiometabolic parameters were collected at baseline and at the end of treatments.Results: Mean age was 63.2 ± 7.9 years (female 46.9%). Baseline characteristics did not differ between two groups. At 6 months, HbA 1C significantly decreased in both dapaglifozin and vildagliptin groups (0.6 ± 1.0% vs 0.8 ± 1.4%, P = 0.22, respectively). There was no difference between the changes in lipid profiles. Body mass index decreased in patients receiving dapagliflozin, whereas it increased in those receiving vildagliptin (−1.27 [95% confidence interval −2.01, −0.53] vs 1.72 [0.72, 2.72] kg, P < 0.001). The reduction in systolic blood pressure and high-sensitivity troponin T was observed in the dapagliflozin group (−9.87 [−18.00, −1.15] mmHg and 2.49 [−4.50, −0.47] pg/mL) but not in vildagliptin group (−1.97 [−9.42, 5.48] mmHg and 1.98 [−0.02, 3.97] pg/mL). The mean haemoglobin increased in the dapagliflozin group, whereas the mean platelet volume increased in the vildagliptin group. There was no significant change in the inflammatory markers in both the groups. Conclusions: The extraglycaemic effects of dapagliflozin and vildagliptin on cardiometabolic parameters in T2D with CAD were different. The more favourable effects Abbreviations: ACS, Acute coronary syndrome; CAD, Coronary artery disease; DPP-4, Dipeptidyl peptidase-4; GLP-1, Glucagon like peptide-1; SGLT2, Sodium glucose co-transporter 2The authors confirm that the PI for this paper is Arintaya Phrommintikul and that she had direct clinical responsibility for patients

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Section: Discussionsupporting

confidence: 90%

Effects of dapagliflozin vs vildagliptin on cardiometabolic parameters in diabetic patients with coronary artery disease: a randomised study

Phrommintikul

Wongcharoen

Kumfu

et al. 2019

Brit J Clinical Pharma

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“…GLP-1RAs and SGLT-2is are very effective medications that continue to be clearly indicated in the management of type 2 diabetes. Both classes can reduce haemoglobin A1c levels 15,25,28,43,44 and cause weight loss, which subsequently may improve insulin Thus, questioning patients as a mean of guiding treatment options remains necessary, and this should not be limited to cardiovascular risk, but should address the risk of hypoglycaemia and possible adverse effects. In black patients with established cardiovascular disease but without a history of pancreatitis, amputation or peripheral arterial disease, the use of GLP-1RAs or SGLT-2is may still be favoured, although limited data exists.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, we used the seven-point modified Oxford Score. [24][25][26] The same two authors extracted the data and created a data collection sheet including:…”

Section: Study Selectionmentioning

confidence: 99%

Do GLP‐1RAs and SGLT‐2is reduce cardiovascular events in black patients with type 2 diabetes? A systematic review and meta‐analysis

Mishriky

Powell

Wittwer

et al. 2019

Diabetes Obesity Metabolism

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Aims While recent cardiovascular safety trials (CVST) concerning newer diabetes medications included mostly white participants, results are being generalized to all races in recent guidelines. This raises a controversial question regarding the appropriateness of applying CVST data to black patients with type 2 diabetes. Materials and methods We searched for randomized trials comparing diabetes medications to placebo in type 2 diabetes and investigated three‐ or four‐point major adverse cardiovascular events (MACE). Data concerning black patients were then extracted. As the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) updated their recommendations for patients with established cardiovascular risk based on the CVST showing cardiovascular benefit, we performed a sensitivity analysis by including those trials only. Results A total of 11 trials were included, investigating a glucagon‐like peptide‐1 receptor agonist (GLP‐1RA) in five, a sodium‐glucose co‐transporter‐2 inhibitor (SGLT‐2i) in two and dipeptidyl peptidase‐4 inhibitors (DPP‐4i) in four. Of the 102 416 participants enrolled in the included trials, only 4601 were black (4.5%). Pooled results showed no significant difference in the incidence of MACE among diabetes medications (GLP‐1RA, SGLT‐2i or DPP‐4i) and placebo in black patients with type 2 diabetes (relative risk [RR] [95% CI], 0.94 [0.77,1.16]). Restricting the analysis to different classes of diabetes medication, the results remained non‐significant. Restricting the analysis to CVST with significant outcomes, the results remained non‐significant (RR [95% CI], 0.97 [0.68,1.39]). Conclusions Given that black patients with type 2 diabetes were not well represented in CVSTs and such trials were underpowered to evaluate racial differences, it remains unclear whether GLP‐1RAs or SGLT‐2is would reduce cardiovascular risk in such patients, and additional studies targeting black patients are urgently needed.

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“…SGLT-2 inhibitors (canagliflozin, dapagliflozin, empagliflozine, ertugliflozin) are effective antihyperglycaemic substances in the treatment of type 2 diabetes in both mono-and combination therapy with all other glucose-lowering drugs. Their efficacy profile is favourable, also because the risk of hypoglycaemia is low, patients lose weight and there is a clinically relevant reduction in systolic blood pressure [70][71][72][73][74][75][76][77]. They also significantly reduce cardiovascular and renal endpoints (see below).…”

Section: Sglt-2 Inhibitorsmentioning

confidence: 99%

Therapy of Type 2 Diabetes

Landgraf

Aberle

Birkenfeld

et al. 2019

Exp Clin Endocrinol Diabetes

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The practical recommendations of the German Diabetes Society/ Deutsche Diabetes Gesellschaft (DDG) together with the German Society for Internal Medicine/Deutschen Gesellschaft für Innere Medizin (DGIM) are based on the contents of the National Treatment Guideline (Nationale Versorgungsleitlinie NVL) "Therapy of Type 2 Diabetes" [1]. The modifications in therapy and their justifications made in the present DDG practical recommendations were updated on the basis of new randomized controlled trials (RCTs) and meta-analyses and were consented by the DDG and the DGIM. Definition of Type 2 DiabetesType 2 diabetes is a chronic, very heterogeneous, multi-factorial, progressive disease characterized by inherited and acquired insulin resistance and qualitative and quantitative insulin secretion disturbances.Influenceable and uninfluenceable risk factors for type 2 diabetes are listed in the "Risk factors for type 2 diabetes" infobox. Therapeutic goalsIn the present recommendations, target ranges are identified which -with varying levels of strengths of evidence -inform the physician and the patient on which target range/target value should be aimed for according to current medical knowledge based on evidence and consensus. The main objective remains to set individual therapy goals primarily together with the patient and possibly his or her relatives and agreeing them optimally in writing on a quarterly basis (e. g. in the Health Passport Diabetes). General and specific therapeutic goalsThe therapeutic goals of people with type 2 diabetes depend on patient preference, comorbidity, duration of the disease, age and life expectancy, quality of life, cultural conditions, psychosocial circumstances and possibilities as well as abilities of the persons S73This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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Comparing SGLT-2 inhibitors to DPP-4 inhibitors as an add-on therapy to metformin in patients with type 2 diabetes: A systematic review and meta-analysis

Cited by 39 publications

References 32 publications

Effects of dapagliflozin vs vildagliptin on cardiometabolic parameters in diabetic patients with coronary artery disease: a randomised study

Effects of dapagliflozin vs vildagliptin on cardiometabolic parameters in diabetic patients with coronary artery disease: a randomised study

Do GLP‐1RAs and SGLT‐2is reduce cardiovascular events in black patients with type 2 diabetes? A systematic review and meta‐analysis

Therapy of Type 2 Diabetes

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