Dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter-2 inhibitors for people with cardiovascular disease: a network meta-analysis

Kanie, Takayoshi; Mizuno, Atsushi; Yoneoka, Daisuke; Tam, Wilson Wai San; Morze, Jakub; Rynkiewicz, Andrzej; Xin, Yiqiao; Wu, Olívia; Kwong, Joey S.W.

doi:10.1002/14651858.cd013650

Cited by 15 publications

(28 citation statements)

References 64 publications

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“…Es zeigte sich auch keine Reduktion der Hospitalisierung wegen Herzinsuffizienz (OR 0,99, 95 % CI 0,80-1,23). DPP-4-Inhibitoren waren nicht mit einer Verschlechterung der Nierenfunktion (OR 1,08, 95 % CI 0,88-1,33) assoziiert und führten nicht zu einem erhöhten Fraktur-Risiko (OR 1,00, 95 % CI 0,83 to 1,19) oder zu Hypoglykämien (OR 1,11, 95 % CI 0,95-1,29) [79].…”

Section: Ddg-praxisempfehlungunclassified

“…Die Autoren gaben jedoch an, dass die Fallzahl zu gering war, um eine eindeutige Aussage zu machen [88]. Auch die neue Cochrane Analyse berichtet über ein signifikant erhöhtes Risiko für Pankreatitiden (OR 1,63, 95 % CI 1,12-2,37) [79]. Daher ist bei Menschen mit Typ-2-Diabetes und einer Pankreatitis in der Anamnese oder einem entsprechenden Risiko beim Einsatz der DPP-4-Inhibitoren große Vorsicht geboten.…”

Section: Sicherheitsaspekteunclassified

“…Der Cochrane Review aus dem Jahr 2021 zeigte, dass SGLT2-Hemmer das Risiko für kardiovaskuläre Mortalität OR 0,82, 95 % CI 0,70-0,95), Gesamtmortalität (OR 0,84, 95 % CI 0,74-0,96), die Hospitalisierung wegen Herzinsuffizienz (OR 0,65, 95 % CI 0,59-0,71) und die Inzidenz für eine Verschlechterung der Niereninsuffizienz (OR 0,59, 95 % CI 0,43-0,82) reduzierten. Das Risiko für Myokardinfarkt (OR 0,97, 95 % CI 0,84-1,12) und für Schlaganfall (OR 1,12, 95 % CI 0,92-1,36) wurde jedoch nicht vermindert [79]. Kaze et al [149] wertete (Meta-Analyse) bei Menschen mit einer Niereninsuffienz die Sicherheit von SGLT-2-Inhibitoren aus.…”

Section: Effekte Auf Kardiovaskuläre Und Renale Endpunkteunclassified

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Therapie des Typ-2-Diabetes

Landgraf

Aberle

Birkenfeld

et al. 2022

Diabetologie und Stoffwechsel

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Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages. ▶ Abb. 3 Algorithmus zur Insulintherapie. Quelle: Nationale VersorgungsLeitlinien. NVL-2-Diabetes -Teilpublikation, 2. Auflage: www.leitlinien. de/themen/diabetes. [rerif]. Diese Abbildung dient als Ergänzung zu Abb. 2. Der Algorithmus bezieht sich nicht auf Menschen mit schwerer Stoffwechseldekompensation bzw. Notfallsituationen. Aktuelle Fachinformationen sind zu berücksichtigen. Überprüfung der Therapiestrategie und des Therapieziels in spätestens 3-6 Monaten.

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Section: Ddg-praxisempfehlungunclassified

Section: Sicherheitsaspekteunclassified

Section: Effekte Auf Kardiovaskuläre Und Renale Endpunkteunclassified

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Therapie des Typ-2-Diabetes

Landgraf

Aberle

Birkenfeld

et al. 2022

Diabetologie und Stoffwechsel

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“…SGLT2i are novel agents that act independently via non-beta cell renal glucosuria [26] and GLP-1a potentiate the incretin hormonal response to enhance glucosedependent insulin secretion and inhibit glucagon secretion [27]. Fortuitously both SGLT2i and GLP-1a have shown improvement in CVD outcomes by reducing major adverse cardiovascular events (MACE) in randomized trials [28]. Although both pharmaceuticals are now vigorously promoted in diabetes management, very little is known about the interaction with fitness promotion, which is especially important in view of prior studies suggesting an attenuation with the combination of medications such as statins and metformin and exercise performance [19,29].…”

Section: Newer Diabetes Agentsmentioning

confidence: 99%

“…Metabolically, SGLT2i use results in weight loss, lower blood pressure, and mild ketogenesis with glucagonemia. Multiple cardiovascular outcomes trials (CVOT) trials in DM2 have established that SGLT2i's improve CVD outcomes [28]. For example, in the EMPA-REG OUTCOME study, Empagliflozin treatment of DM2 and CVD resulted in reduced MACE, death and hospitalization for heart failure [32].…”

Section: Sglt2i and Physical Activitymentioning

confidence: 99%

Newer Diabetes Management Options and Physical Fitness to Promote Cardiovascular Benefits

Nylén¹

2022

Rev. Cardiovasc. Med.

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A plethora of diabetes studies and established clinical guidelines show the strong salutary benefit of aerobic, resistance, and/or combination exercise for improved glycemic and cardiovascular outcomes. Promotion of physical fitness is a cornerstone approach to improved diabetes management especially since subjects with diabetes have reduced baseline aerobic exercise capacity (i.e., reduced cardiorespiratory fitness) with associated increased risk for premature all-cause and cardiovascular mortality. Since medications are often used in conjunction with fitness promotion this can result in complex interaction between management modalities. More recently, newer options such as glucose transporter-2 inhibitors and incretin agonists have shown to improve cardiovascular disease (CVD) outcomes in cardiovascular outcomes trials. Indeed, both classes of agents have experimentally the potential to synergize with exercise training but clinical data vis-à-vis cardiorespiratory fitness is still preliminary. Review of the interaction of exercise and metformin shows no improvement in cardiorespiratory fitness. The use of glucose transporter-2 inhibitors may improve fitness performance in those with diabetes and heart failure. Although incretin agonists have physiological effects on the vasculature and heart, they lack similar clinical supportive data.

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Evaluation of the Effect of Sodium-Glucose Cotransporter 2 Inhibition on Fracture Risk: Evidence From Mendelian Randomization and Genetic Association Study

Dai

Zheng

Zhu

et al. 2023

Journal of Bone and Mineral Research

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This study aims to evaluate the causal effect of sodium‐glucose cotransporter 2 (SGLT2) inhibition on bone mineral density (BMD), osteoporosis, and fracture risk using genetics. Two‐sample Mendelian randomization (MR) analyses were performed utilizing two sets of genetic variants as instruments (six and two single‐nucleotide polymorphisms [SNPs]) associated with SLC5A2 gene expression and glycated hemoglobin A1c levels. Summary statistics of BMD from the Genetic Factors for Osteoporosis consortium (BMD for total body, n = 66,628; femoral neck, n = 32,735; lumbar spine, n = 28,498; forearm, n = 8143) and osteoporosis (6303 cases, 325,717 controls) and 13 types of fracture (≤17,690 cases, ≤328,382 controls) data from the FinnGen study were obtained. One‐sample MR and genetic association analyses were conducted in UK Biobank using the individual‐level data of heel BMD (n = 256,286) and incident osteoporosis (13,677 cases, 430,262 controls) and fracture (25,806 cases, 407,081 controls). Using six SNPs as the instrument, genetically proxied SGLT2 inhibition showed little evidence of association with BMD of total body, femoral neck, lumbar spine, and forearm (all p ≥ 0.077). Similar results were observed using two SNPs as instruments. Little evidence was found for the SGLT2 inhibition effect on osteoporosis (all p ≥ 0.112) or any 11 major types of fracture (all p ≥ 0.094), except for a nominal significance for fracture of lower leg (p = 0.049) and shoulder and upper arm (p = 0.029). One‐sample MR and genetic association analysis showed that both the weighted genetic risk scores constructed from the six and two SNPs were not causally associated with heel BMD, osteoporosis, and fracture (all p ≥ 0.387). Therefore, this study does not support an effect of genetically proxied SGLT2 inhibition on fracture risk. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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Dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter-2 inhibitors for people with cardiovascular disease: a network meta-analysis

Abstract: Dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter-2 inhibitors for people with cardiovascular disease: a network meta-analysis.

Cited by 15 publications

References 64 publications

Therapie des Typ-2-Diabetes

Therapie des Typ-2-Diabetes

Newer Diabetes Management Options and Physical Fitness to Promote Cardiovascular Benefits

Evaluation of the Effect of Sodium-Glucose Cotransporter 2 Inhibition on Fracture Risk: Evidence From Mendelian Randomization and Genetic Association Study

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