Comparative effectiveness of cardiovascular, renal and safety outcomes of second‐line antidiabetic drugs use in people with type 2 diabetes: A systematic review and network meta‐analysis of randomised controlled trials

Abstract

Aims: To compare the cardiovascular, renal and safety outcomes of second-line glucose-lowering agents used in the management of people with type 2 diabetes.Methods: MEDLINE, EMBASE and CENTRAL were searched from inception to 13 July 2021 for randomised controlled trials comparing second-line glucose lowering therapies with placebo, standard care or one another. Primary outcomes included cardiovascular and renal outcomes. Secondary outcomes were non-cardiovascular adverse events. Risk ratios (RRs) and corresponding confidence intervals (CI) or credible intervals (CrI) were reported within pairwise and network meta-analysis. The quality of evidence was evaluated using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) criteria. Number needed to treat (NNT) and number needed (NNH) to harm were calculated at 5 years using incidence rates and RRs. PROSPERO (CRD42020168322). Results:We included 38 trials from seven classes of glucose-lowering therapies. Both sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP1RA) showed moderate to high certainty in reducing risk of 3-point major adverse cardiovascular events, 3P-MACE

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

“…SGLT-2is have been shown to reduce the incidence of HHF also in subjects without diabetes, 21,59,60 and they are currently indicated for the treatment of heart failure with reduced ejection fraction, regardless of the presence or absence of T2DM. The present metaanalysis confirms that treatment with SGLT2i leads to a significant reduction in HHF also in patients with T2DM, with a high degree of certainty of evidence at GRADE rating.…”

Recomendaciones preventivas cardiovasculares. Actualización PAPPS 2022

“…Los iSGLT2 también mostraron una reducción del riesgo de hospitalización por insuficiencia cardíaca, enfermedad renal terminal, lesión renal aguda, duplicación de la creatinina sérica y disminución de la tasa de filtración glomerular. Los arGLP1 se asociaron a un menor riesgo de ictus, mientras que el uso de glitazona se asoció a un mayor riesgo de IC 171 . No obstante, pioglitazona ha mostrado tambien beneficios sobre eventos CV arterioscleróticos, muy especialmente ictus.…”

Exploring Anti-Type 2 Diabetes Mellitus Mechanism of Gegen Qinlian Decoction by Network Pharmacology and Experimental Validation

“…The goals of diabetes management are to maintain their quality of life by keeping their blood sugar levels as close to normal as possible and within a target range and prevent or delay the development of various diabetic complications [4]. Over the past decades, a large number of glucose-lowering medications have been approved for clinical use in the control of T2DM, but most drugs have certain adverse reactions, such as hypoglycemia, gastrointestinal symptoms, oedema, osteoporosis, lactic acidosis, and urinary tract infection [5][6][7]. In addition, the management of complications of T2DM is still a major challenge in clinical practice and a substantial global healthcare burden [8].…”