Effects of sodium-glucose cotransporter-2 inhibitors on cardiovascular events, death, and major safety outcomes in adults with type 2 diabetes: a systematic review and meta-analysis

Wu, Jason; Foote, Celine; Blomster, Juuso; Toyama, Tadashi; Perkovic, Vlado; Sundström, Johan; Neal, Bruce

doi:10.1016/s2213-8587(16)00052-8

Cited by 412 publications

(409 citation statements)

References 56 publications

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“…The GFR effect led to initial concern that SGLT2i may increase the risk of AKI. These data support mechanistic studies that suggest proximal tubular natriuresis activates tubuleglomerular feedback through increased macula densa sodium delivery, leading to afferent arteriole vasoconstriction and reduction in intraglomerular pressure (4).…”

Section: Main Kidney Findings In the Published Clinical Trialssupporting

confidence: 85%

Are SGLT2 Inhibitors Ready for Prime Time for CKD?

Pécoits-Filho

Perkovic

2017

CJASN

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Section: Main Kidney Findings In the Published Clinical Trialssupporting

confidence: 85%

Are SGLT2 Inhibitors Ready for Prime Time for CKD?

Pécoits-Filho

Perkovic

2017

CJASN

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“…Enfin, quelques cas d'acidocétose ont été rapportés. Les résultats remarquables de l'étude EMPA-REG OUTCOME montrent un effet rapidement favorable de l'empagliflozine avec une diminution de 38% de la mortalité cardiovasculaire et de 35% des hospitalisations pour insuffisance cardiaque mais avec une petite majoration des AVC [36]. Toutefois, leur prescription sera probablement limitée chez les sujets âgés en raison de la gêne due à la polyurie et des symptômes liés à l'hypovolémie.…”

Section: ) Prescription D'une Bithérapie En Cas D'insuffisance De Launclassified

Management of Diabetes in Elderly

Bauduceau

Bordier

2017

IJMS

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RESUMELa prise en charge des patients diabétiques âgés est devenue aujourd'hui un véritable problème de santé publique du fait de l'augmentation du nombre des malades. Dans cette population, les complications du diabète sont plus graves et s'intriquent avec les manifestations plus spécifiquement gérontologiques. L'évaluation gériatrique standardisée est indispensable pour définir la situation de chaque malade selon son degré d'autonomie et de dénutrition, ses fonctions cognitives et son environnement social. Les objectifs thérapeutiques doivent être individualisés en fonction de la présentation clinique du patient. L'insulinothérapie est fréquemment incontournable et nécessite l'éducation du patient ou de son entourage. La prise en charge des patients diabétiques âgés doit éviter un trop grand laxisme chez une personne restée en bonne santé mais aussi un activisme déraisonnable chez les sujets fragiles en raison du risque hypoglycémique. MOTS CLÉS :Diabète, Sujet Agé, Complications, Insuline, Hypoglycémie. ABSTRACTThe management of elderly diabetic patients has become a real public health problem due to the increase in the number of patients. In this population, the complications of diabetes are more serious and are associated with manifestations more specifically gerontological. The standardized geriatric assessment is essential to define the situation of each patient according to his degree of autonomy and undernutrition, his cognitive functions and his social environment. The therapeutic objectives must be individualized according to the clinical status of the patient. Insulin therapy is often unavoidable and requires a good education of the patient or his family. The management of diabetes in elderly patients must also avoid too much laxity in a person who is remained healthy but also an unreasonable activism in the fragile subjects due to the hypoglycemic risk.

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“…78 In the liraglutide effect and action in diabetes: Evaluation Of Cardiovascular Outcome Results (LEADER) trial, which randomized 9340 T2DM patients with high cardiovascular risk, liraglutide reduced the primary composite endpoint of cardiovascular death, non-fatal MI or non-fatal stroke compared to placebo after a median follow-up of 3years. 79,80 Although not currently FDA approved, semaglutide, a once-weekly GLP-1 agonist, was non-inferior to placebo after 26 months follow up among 3297 patients with T2DM in the Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes (SUSTAIN-6) with regards to the primary composite endpoint of cardiovascular death, non-fatal MI and nonfatal stroke. 81 Notably, majority of the trial patients had established cardiovascular disease, stage 3 or higher chronic kidney disease, or both at baseline.…”

Section: Cardiovascular Safetymentioning

confidence: 99%

“…75,79,81,82 Inhibition of SGLT-2 lowers blood glucose by promoting renal glucose excretion, which is independent of β-cell function and thus carries a low risk for hypoglycemia. 77,78,80,82 Currently, 3 agents are approved in the United States and Europe: dapagliflozin, canagliflozin, and empagliflozin. SGLT-2 inhibitors reduce HbA1c by 0.5-0.7% compared with placebo.…”

Section: Sodium Glucose Cotransporter-2 Inhibitorsmentioning

confidence: 99%

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Cardiovascular safety of oral antidiabetic therapy in type 2 diabetes mellitus- review article

et al. 2017

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Cardiovascular disease is the leading cause of morbidity and mortality among patients with type 2 diabetes mellitus (DM). There is twofold increased risk of cardiovascular (CV) mortality among diabetic patients as compared with nondiabetic patients. The glycemic efficacy of anti-diabetic drugs does not necessarily provide cardiovascular safety. Since 2008, US Food and Drug Administration has recommended that new drugs for type 2 DM should undergo clinical trials to demonstrate cardiovascular safety in addition to glycemic benefit. In 2012, European medicine agencies issued a similar recommendation. In this review, we have tried to examine the cardiovascular safety of oral antidiabetic agents in major published trials. Metformin remains the initial drug of choice in type2 DM till date. The sulfonylureas, one of oldest oral anti-diabetic drugs, have adverse cardiovascular events and are gradually being out classed by other second line drugs. The glitazones have been found to have adverse outcome in heart failure. The incretin based drugs have been found to have cardiovascular safety in various trials in recent past and their performances have been reassuring. There is lack of enough cardiovascular outcome data for meglitinides and glucosidase inhibitors. Various current trials have found sodium glucose cotransporter-2 inhibitors to have a potential for cardiovascular benefit. Careful selection of drug therapy with special attention for cardiovascular risk is important in selection and optimization of diabetic therapy.

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Effects of sodium-glucose cotransporter-2 inhibitors on cardiovascular events, death, and major safety outcomes in adults with type 2 diabetes: a systematic review and meta-analysis

Cited by 412 publications

References 56 publications

Are SGLT2 Inhibitors Ready for Prime Time for CKD?

Are SGLT2 Inhibitors Ready for Prime Time for CKD?

Management of Diabetes in Elderly

Cardiovascular safety of oral antidiabetic therapy in type 2 diabetes mellitus- review article

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