Benefits and harms of sodium‐glucose co‐transporter‐2 inhibitors (SGLT2‐I) and renin–angiotensin–aldosterone system inhibitors (RAAS‐I) versus SGLT2‐Is alone in patients with type 2 diabetes: A systematic review and meta‐analysis of randomized controlled trials

Seidu, Samuel; Kunutsor, Setor K; Topsever, Pınar; Khunti, Kamlesh

doi:10.1002/edm2.303

Cited by 16 publications

(7 citation statements)

References 48 publications

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“…www.nature.com/scientificreports/ Patients using SGLT2i are mostly on combination with ACEI/ARB, which may have a synergistic effect on the kidney 35 . Several studies had shown that the combination of SGLT2i and ACEI/ARB had a better protective effect on heart and kidney, achieved better control of blood glucose, blood pressure and body weight [36][37][38] .…”

Section: Discussionmentioning

confidence: 99%

Integrated analysis for treatment scheme of sodium–glucose cotransporter 2 inhibitors in patients with diabetic kidney disease: a real-world study

Fang

Ren

et al. 2023

Sci Rep

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Sodium–glucose cotransporter 2 inhibitors (SGLT2i) are recommended for type 2 diabetes mellitus patients with impaired renal function, but the actual situation of SGLT2i using is unclear. Therefore, in this real-world study, we analyzed the treatment scheme and clinical characteristics of SGLT2i in patients with diabetic kidney disease (DKD). We included DKD patients hospitalized in the First Affiliated Hospital of Zhengzhou University from October 2017 to March 2020. The Apriori algorithm of association rules was used to analysis treatment scheme prescribing SGLT2i and other different combinations of hypoglycemic drugs. SGLT2i was used in 781 (12.3%) of 6336 DKD patients, both number and proportion of patients using SGLT2i increased from 2017 to 2020 (1.9% to 33%). Nighty-eight percent of all DKD patients using SGLT2i were combined with other glucose-lowering agents, and insulin, metformin and alpha-glucosidase inhibitors are most commonly used in combination with hypoglycemic drugs. Multivariate analysis showed that compared with non-SGLT2i group, patients using SGLT2i were associated with younger age, higher BMI, higher HbA1c, preserved kidney function, dyslipidemia and combined with ACEI/ARB and statins. In this real-world study, use of SGLT2i in DKD patients is still low. Most patients performed younger age and in the early stages of chronic kidney disease with poor glycemic control. Clinical inertia should be overcome to fully exert the cardiorenal protective effects of SGLT2 inhibitors, with attention to rational drug use.

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Section: Discussionmentioning

confidence: 99%

Integrated analysis for treatment scheme of sodium–glucose cotransporter 2 inhibitors in patients with diabetic kidney disease: a real-world study

Fang

Ren

et al. 2023

Sci Rep

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“…Thus, the cardiorenal protective effect of SGLT2 inhibitors on T2D complicated with CKD is still based on the combined application of RAAS blockade. Another recent meta‐analysis 24 demonstrated that the combination of SGLT2 inhibitors and RAAS inhibitors in the treatment of patients with T2D may be similar in efficacy and safety, if not superior to SGLT2 inhibitors alone. However, all the qualifying studies in their research were based on trials that evaluated the efficacy of SGLT2 inhibitors compared to placebo in T2D and reported subgroup data for those treated with or without RAAS at baseline.…”

Section: Discussionmentioning

confidence: 99%

Effects of sodium‐glucose cotransporter‐2 inhibitors and aldosterone antagonists, in addition to renin‐angiotensin system antagonists, on major adverse kidney outcomes in patients with type 2 diabetes and chronic kidney disease: A systematic review and network meta‐analysis

Yang

Zhao

et al. 2022

Diabetes Obesity Metabolism

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Aims: To compare the efficacy of sodium-glucose cotransporter-2 (SGLT2) inhibitors, nonsteroidal mineralocorticoid receptor antagonists (MRAs), selective aldosterone antagonists and nonselective aldosterone antagonists, on top of renin-angiotensinaldosterone system (RAAS) blockade, in reducing kidney-specific composite events, cardiovascular outcomes, and other events of special interest in participants with type 2 diabetes (T2D) and chronic kidney disease (CKD).Methods: PubMed, EMBASE and CENTRAL were searched for studies published up to January 20, 2022. Randomized clinical trials enrolling participants with T2D and CKD were included, in which SGLT2 inhibitors, nonsteroidal MRAs, selective aldosterone antagonists and nonselective aldosterone antagonists were compared with either each other, or with placebo or no treatment. A network meta-analysis using a Bayesian approach was performed. The primary outcome was a kidney-specific composite event. Secondary outcomes included death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, and allcause mortality. We also examined blood pressure and safety outcomes of interest, including acute kidney injury, hyperkalaemia, hyponatraemia, and volume reduction events. All research was conducted according to a protocol registered in the PROSPERO database (CRD42022307113).Results: This meta-analysis of 17 trials randomizing 22 981 participants found SGLT2 inhibitors (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.52 to 0.73) and nonsteroidal MRAs (OR 0.76, 95% CI 0.66 to 0.88) were associated with significantly lower kidney-specific composite events than the control groups. Nonsteroidal MRAs (OR 0.78, 95% CI 0.66 to 0.92) and SGLT2 inhibitors (OR 0.57, 95% CI 0.45 to 0.72) were associated with greater reductions in hospitalization for heart failure than the control groups. SGLT2 inhibitors were associated with a lower risk of hospitalization for heart failure events compared with nonsteroidal MRAs (OR 0.73, 95% CI 0.55-0.97). SGLT2 inhibitors were associated with a reduction in cardiovascular death (OR 0.80, 95% CI 0.65 to 0.98) and all-cause mortality (OR 0.79, 95% CI 0.66 to 0.93) compared with the control groups. When compared to the control groups,

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“…A standardised predesigned data collection form, utilised in previous similar reviews, 23 , 24 was used for data extraction. For each study, data regarding first author and year of publication, study design and baseline characteristics, intervention and comparator characteristics, and outcomes were extracted.…”

Section: Methodsmentioning

confidence: 99%

“…To compare the effect of intensive versus standard BP control on outcomes in those with or without DM, we conducted interaction analyses using meta-regression techniques as done previously. 24 A narrative synthesis was performed for a few studies that could not be pooled. All analyses were conducted using Stata version MP 17 (Stata Corp, College Station, TX, USA).…”

Section: Methodsmentioning

confidence: 99%

Intensive versus standard blood pressure control in older persons with or without diabetes: a systematic review and meta-analysis of randomised controlled trials

et al. 2023

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Objectives To assess and compare the benefits and harms of intensive versus standard blood pressure (BP) control in older people with or without diabetes mellitus (DM). Design Systematic review and meta-analysis Setting Randomised controlled trials comparing intensive versus standard BP control, identified from MEDLINE, Embase, The Cochrane library, Web of Science and a search of bibliographies from inception till August 2022. Participants Older people (≥65 years) with or without DM. Main outcome measures Study-specific risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for adverse vascular and safety outcomes. Results We included six randomised controlled trials (RCTs) comprising 20,985 patients (intensive BP = 10,474 and standard BP = 10,511) with a weighted mean follow-up of 3.1 years. In the general population, the RRs (95% CIs) of intensive versus standard BP control for composite cardiovascular events or major adverse cardiovascular events (CVD/MACE), CVD mortality, coronary heart disease, stroke and heart failure were 0.71 (0.62–0.82), 0.65 (0.49–0.86), 0.75 (0.60–0.95), 0.75 (0.61–0.92) and 0.58 (0.41–0.82), respectively. Intensive BP control did not increase the risk of renal failure or serious adverse events in the general population. Two RCTs reported results for composite CVD/MACE in patients with DM with a pooled estimate of 0.85 (0.67–1.07). Conclusions Aggregate trial evidence shows that intensive BP control (<120 to <140 mmHg) reduces the risk of adverse cardiovascular outcomes in older hypertensive patients in the general population with no increase in adverse events. Intensive BP control may confer similar benefits for older patients with DM with no evidence for harm, but this is based on limited data. PROSPERO Registration: CRD42022349791

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Benefits and harms of sodium‐glucose co‐transporter‐2 inhibitors (SGLT2‐I) and renin–angiotensin–aldosterone system inhibitors (RAAS‐I) versus SGLT2‐Is alone in patients with type 2 diabetes: A systematic review and meta‐analysis of randomized controlled trials

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 16 publications

References 48 publications

Integrated analysis for treatment scheme of sodium–glucose cotransporter 2 inhibitors in patients with diabetic kidney disease: a real-world study

Integrated analysis for treatment scheme of sodium–glucose cotransporter 2 inhibitors in patients with diabetic kidney disease: a real-world study

Effects of sodium‐glucose cotransporter‐2 inhibitors and aldosterone antagonists, in addition to renin‐angiotensin system antagonists, on major adverse kidney outcomes in patients with type 2 diabetes and chronic kidney disease: A systematic review and network meta‐analysis

Intensive versus standard blood pressure control in older persons with or without diabetes: a systematic review and meta-analysis of randomised controlled trials

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