Glycemic Variability Impacted by SGLT2 Inhibitors and GLP 1 Agonists in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis

Lee, Heeyoung; Park, Se-Eun; Kim, Eun Young

doi:10.3390/jcm10184078

Cited by 17 publications

(10 citation statements)

References 43 publications

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“…This mechanism was confirmed by improved cardiovascular outcomes in acute coronary syndrome patients with strict glycemic control ( 41 , 42 ). A recent meta-analysis that included 16 studies showed that SGLT-2 inhibitors could effectively reduce the mean amplitude of glucose excursion and glycemic variability ( 43 ). Since AT1R/NADPH oxidase/SGLT1 and 2 pathways promote endothelial dysfunction, SGLT-2i provide a promising strategy to ameliorate endothelial function.…”

Section: Discussionmentioning

confidence: 99%

Effects of SGLT-2 Inhibitors on Vascular Endothelial Function and Arterial Stiffness in Subjects With Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2022

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ObjectiveThis systematic review and meta-analysis aimed to evaluate the effects of SGLT-2 inhibitors (SGLT-2i) on endothelial function and arteriosclerosis in diabetic patients.MethodsRandomized controlled trials (RCTs) were retrieved from PubMed, Embase, Cochrane Library, and Web of Science databases to evaluate the effects of SGLT-2i on endothelial function and atherosclerosis in type 2 diabetic patients.ResultsWe selected 9 RCTs and 2 cohort studys involving 868 patients. Of these, six studies provided flow-mediated dilation (FMD) levels before and after the intervention. The pooled analysis showed that SGLT-2i could significantly improve the FMD compared to the control group (SMD: 0.18, 95% CI: 0.02 ~ 0.34, P = 0.03). Three studies provided the change in FMD before and after the intervention. Pooled analysis showed no significant differences in FMD change between the SGLT-2i group and the control group. (MD: 2.1, 95%-CI: -0.11~4.31, P = 0.06). Five studies showed pulse wave velocity (PWV) results. Pooled analysis showed no significant differences in the change in PWV between the SGLT-2i group and the control group (SMD: 0.11, 95%-CI: − 0.15 ~ 0.37, P = 0.4).ConclusionsThe ability of SGLT-2 inhibitors to improve FMD was significant, but there was no significant effect on PWV levels. SGLT-2i was superior to other antidiabetic agents in improving arterial endothelial function.

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Section: Discussionmentioning

confidence: 99%

Effects of SGLT-2 Inhibitors on Vascular Endothelial Function and Arterial Stiffness in Subjects With Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2022

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“…Evidences suggested that brain insulin signaling regulates the homeostasis of peripheral energy metabolism through the autonomic nervous system and hypothalamic–pituitary axis ( 8 , 50 ). The incretins Glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP), which were suggested to be efficacy in restoring insulin sensitivity ( 53 ), have shown potential in reducing GV in patients with Type 2 Diabetes ( 54 , 55 ). The neuroprotective effect of insulin administration has been reported in vivo ( 56 ) and in animal models ( 50 , 51 , 57 ) by alleviating glutamate excitotoxicity and reducing inflammatory response.…”

Section: Discussionmentioning

confidence: 99%

Insulin resistance is associated with an unfavorable outcome among non-diabetic patients with isolated moderate-to-severe traumatic brain injury – A propensity score-matched study

Cao

Wang²,

Gao³

et al. 2022

Front. Neurol.

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BackgroundHyperglycemia is an independent risk factor for the poor prognosis in patients with traumatic brain injury (TBI), and stress-induced impaired insulin function is the major factor of hyperglycemia in non-diabetic patients with TBI. Several types of research suggested that insulin resistance (IR) is related to the poor prognosis of neurocritical ill patients; here we focused on the role of IR in non-diabetic patients after TBI.MethodsWe performed a prospective observational study with the approval of the Ethics Committee of our institute. IR was accessed via the update Homeostasis Model Assessment (HOMA2) of IR, a computer-calculated index by glucose and insulin level. HOMA2 ≥ 1.4 was considered as the threshold of IR according to the previous studies. The glycemic variability (GV) indices were calculated by fingertip blood glucose concentration at an interval of 2 h within 24 h to explore the relationship between IR and GV. The outcome was the 6-month neurological outcome evaluated with the Glasgow outcome scale.ResultsA total of 85 patients with isolated moderate-to-severe TBI (admission GCS ≤ 12) were finally included in our study, 34 (40%) were diagnosed with IR with HOMA2 ≥ 1.4. After propensity score matching (PSM), 22 patients in IR group were matched to 34 patients in non-IR group. Patients with IR suffered increased systemic glycemic variation after isolated moderate-to-severe TBI. IR was a significant factor for the poor prognosis after TBI (OR = 3.25, 95% CI 1.03–10.31, p = 0.041).ConclusionsThe IR estimated by HOMA2 was associated with greater GV and an unfavorable outcome after isolated moderate-to-severe TBI. Ameliorating impaired insulin sensitivity may be a potential therapeutic strategy for the management of TBI patients.

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“… 10 Thus, MAGE may be able to better represent glucose fluctuation in this context. 7 , 11 Hence, in the current study, we used MAGE as a primary GV metric due to its extensibility.…”

Section: Introductionmentioning

confidence: 99%

“… 14 In addition, Heeyoung Lee et al compared and analyzed GLP-1 RAs and SGLT-2 inhibitors. 11 According to published studies, SGLT-2 inhibitors, GLP-1 RAs, and DPP-4 inhibitors show pharmacological differences in their mechanisms of action, but effectively reduce glucose levels, complications, and GV in diabetic patients. 11 , 14 However, in existing studies, it is difficult to ascertain the differences between individual drugs because direct comparison drugs for each drug pair exist in part.…”

Section: Introductionmentioning

confidence: 99%

“… 11 According to published studies, SGLT-2 inhibitors, GLP-1 RAs, and DPP-4 inhibitors show pharmacological differences in their mechanisms of action, but effectively reduce glucose levels, complications, and GV in diabetic patients. 11 , 14 However, in existing studies, it is difficult to ascertain the differences between individual drugs because direct comparison drugs for each drug pair exist in part. Although there have been indirect studies regarding HbA1c reduction between antidiabetic treatment pairs, 15 there have been no studies on MAGE, which is another parameter that indicates differences between GV fluctuations.…”

Section: Introductionmentioning

confidence: 99%

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Hypoglycemic agents and glycemic variability in individuals with type 2 diabetes: A systematic review and network meta-analysis

Purja

Shin

et al. 2022

Diabetes and Vascular Disease Research

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While hemoglobin A1c (HbA1c) is commonly used to monitor therapy response in type 2 diabetes (T2D), GV is emerging as an essential additional metric for optimizing glycemic control. Our goal was to learn more about the impact of hypoglycemic agents on HbA1c levels and GV in patients with T2D. A systematic review and network meta-analysis (NMA) of randomized controlled trials were performed to assess the effects of glucagon-like peptide 1 receptor agonists (GLP-1 RAs), sodium-glucose cotransporter (SGLT)-2 inhibitors, dipeptidyl peptidase (DPP)-4 inhibitors, sulfonylurea and thiazolidinediones on Mean Amplitude of Glycemic Excursions (MAGE) and HbA1c. Searches were performed using PubMed and EMBASE. A random-effect model was used in the NMA, and the surface under the cumulative ranking was used to rank comparisons. All studies were checked for quality according to their design and also for heterogeneity before inclusion in this NMA. The highest reduction in MAGE was achieved by GLP-1 RAs (SUCRA 0.83), followed by DPP-4 inhibitors (SUCRA: 0.72), and thiazolidinediones (SUCRA: 0.69). In terms of HbA1c reduction, GLP-1 RAs were the most effective (SUCRA 0.81), followed by DPP-4 inhibitors (SUCRA 0.72) and sulfonylurea (SUCRA 0.65). Our findings indicated that GLP-1 RAs have relatively high efficacy in terms of HbA1c and MAGE reduction when compared with other hypoglycemic agents and can thus have clinical application. Future studies with a larger sample size and appropriate subgroup analyses are warranted to completely understand the glycemic effects of these agents in various patients with T2D. The protocol for this systematic review was registered with the International Prospective Register of Systematic Reviews (CRD42021256363).

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Glycemic Variability Impacted by SGLT2 Inhibitors and GLP 1 Agonists in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis

Cited by 17 publications

References 43 publications

Effects of SGLT-2 Inhibitors on Vascular Endothelial Function and Arterial Stiffness in Subjects With Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Effects of SGLT-2 Inhibitors on Vascular Endothelial Function and Arterial Stiffness in Subjects With Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Insulin resistance is associated with an unfavorable outcome among non-diabetic patients with isolated moderate-to-severe traumatic brain injury – A propensity score-matched study

Hypoglycemic agents and glycemic variability in individuals with type 2 diabetes: A systematic review and network meta-analysis

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