scholarly journals SGLT-2 inhibitors and cardiorenal outcomes in patients with or without type 2 diabetes: a meta-analysis of 11 CVOTs

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Dario Giugliano ◽  
Miriam Longo ◽  
Lorenzo Scappaticcio ◽  
Giuseppe Bellastella ◽  
Maria Ida Maiorino ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Meta Analysis ◽  
Total Mortality ◽  
Renal Outcome ◽  
Renal Diseases ◽  
Significant Heterogeneity ◽  
Cardiovascular Outcome Trials ◽  
Renal Outcomes ◽  
Moderate Reduction

Abstract Background It has been suggested that sodium–glucose cotransporter 2 (SGLT-2) inhibitors reduce the cardiorenal risk in patients with type 2 diabetes (T2D). The purpose of this study is to provide an update of all large cardiovascular outcome trials (CVOTs) with SGLT-2 inhibitors to assess their cardiorenal efficacy in patients with and without T2D. Methods An electronic search up to 30 September 2021 was conducted in PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. to determine eligible trials. We included CVOTs comparing any SGLT-2 inhibitor with placebo, reporting desired cardiovascular or renal outcomes and with a follow-up duration of at least 6 months. Results Eleven CVOTs, with data from five SGLT-2 inhibitors (empagliflozin, canagliflozin, dapagliflozin, ertugliflozin and sotagliflozin) and 77,541 participants, were included. In the overall analysis, the risk of the composite CV mortality or hospitalization for heart failure (HF) was reduced by 23% (HR = 0.77, 95% CI 0.73–0.82, P < 0.001) compared with placebo, with not significant heterogeneity (I2 = 26%, P = 0.20), and irrespective of the presence of T2D (P for interaction = 0.81) and age (> 65 vs ≤ 65 years, P for interaction = 0.78). The risk of CV mortality, total mortality and hospitalization for HF was significantly reduced by 16%, 13%, and 32%, respectively; similarly, the risk of the composite renal outcome was reduced by 35% (HR = 0.65, 95% CI 0.56–0.75), with moderate heterogeneity (I2 = 32%). In the analysis of 6 CVOTs reporting the data, the risk of major cardiovascular events (MACE) was reduced by 12%, with low heterogeneity (I2 = 21.2%, P = 0.19) and irrespective of the presence of established CV disease at baseline (P for interaction = 0.46). Conclusions Therapy with SGLT-2 inhibitors in patients with cardiometabolic and renal diseases results in a sustained to moderate reduction of the composite CV death or hospitalization for HF, robust reduction of HF and renal outcomes, moderate reduction of CV mortality, total mortality and MACE.

scholarly journals GLP-1 receptor agonists and cardiorenal outcomes in type 2 diabetes: an updated meta-analysis of eight CVOTs

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Dario Giugliano ◽  
Lorenzo Scappaticcio ◽  
Miriam Longo ◽  
Paola Caruso ◽  
Maria Ida Maiorino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Significant Heterogeneity ◽  
Cardiovascular Outcome Trials ◽  
Receptor Agonists ◽  
All Cause Mortality

Abstract Background A meta-analysis is presented of cardiovascular outcome trials (CVOTs) comparing glucagon-like peptide-1 receptor agonists (GLP-1RA) versus placebo on cardiorenal outcomes in patients with type 2 diabetes mellitus (T2DM). Methods We did an electronic search up to June 30, 2021, for eligible trials. We did a meta-analysis of available trial data using a random-effects model to calculate overall hazard ratios (HRs) and 95% CI (confidence intervals). We included data from 8 CVOTs and 60,080 patients (72.4% with established cardiovascular disease). Results GLP-1RA reduced major cardiovascular events (MACE) by 14% (HR = 0.86, 95% CI 0.79–0.94, P = 0.006) with a non-significant heterogeneity between subgroups of patients with and without cardiovascular disease (P = 0.127). GLP-1RA also reduced the risk of cardiovascular death by 13% (P = 0.016), nonfatal stroke by 16% (P = 0.007), hospitalization for heart failure by 10% (P = 0.023), all-cause mortality by 12% (P = 0.012), and the broad composite kidney outcome by 17% (P = 0.012), which was driven by a reduction in macroalbuminuria only (HR = 0.74, 0.67–0.82, P < 0.001). Conclusions GLP-1RA have moderate benefits on MACE, and also reduce hospitalization for heart failure and all-cause mortality; they also have robust benefits on reducing the incidence of macroalbuminuria.

scholarly journals Prevalence of Type 2 Diabetes in South Africa: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (11) ◽  
pp. 5868
Author(s):  
Carmen Pheiffer ◽  
Victoria Pillay-van Wyk ◽  
Eunice Turawa ◽  
Naomi Levitt ◽  
Andre P. Kengne ◽  
...  
Keyword(s):  
South Africa ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Health Planning ◽  
Meta Analysis ◽  
Population Group ◽  
Significant Heterogeneity ◽  
Newly Diagnosed ◽  
Prevalence Data

Synthesis of existing prevalence data using rigorous systematic review methods is considered an effective strategy to generate representative and robust prevalence figures to inform health planning and policy. The purpose of this systematic review was to identify, collate, and synthesise all studies reporting the prevalence of total and newly diagnosed type 2 diabetes (T2DM), impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) in South Africa. Four databases, PubMed, Scopus, Web of Science, and African Index Medicus were searched for articles published between January 1997 and June 2020. A total of 1886 articles were identified, of which 11 were included in the meta-analysis. The pooled prevalence in individuals 25 years and older was 15.25% (11.07–19.95%) for T2DM, 9.59% (5.82–14.17%) for IGT, 3.55% (0.38–9.61%) for IFG, and 8.29% (4.97–12.34%) for newly diagnosed T2DM. Although our pooled estimate may be imprecise due to significant heterogeneity across studies with regard to population group, age, gender, setting, diagnostic test, and study design, we provide evidence that the burden of glucose intolerance in South Africa is high. These factors contribute to the paucity of representative T2DM prevalence data. There is a need for well-designed epidemiological studies that use best-practice and standardised methods to assess prevalence.

scholarly journals Renal outcomes and clinical course of nondiabetic renal diseases in patients with type 2 diabetes

2013 ◽  
Vol 28 (5) ◽  
pp. 565 ◽  
Author(s):  
Ja Min Byun ◽  
Cheol Hyun Lee ◽  
Sul Ra Lee ◽  
Ju Young Moon ◽  
Sang Ho Lee ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Course ◽  
Renal Diseases ◽  
Renal Outcomes

scholarly journals Impact of Common Spices on Glycemia in Individuals with Type 2 Diabetes: Systematic Review and Meta-Analysis of Clinical Trials

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 2-2
Author(s):  
Sepideh Alasvand ◽  
William Bridges ◽  
Vivian Haley-Zitlin
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Meta Analysis ◽  
Cochrane Library ◽  
P Value ◽  
Significant Heterogeneity ◽  
P Values ◽  
Common Spices

Abstract Objectives This study examined the effect of common spices cardamom, ginger, cumin, curcuminoids and cinnamon on improving glucose levels in individuals with type 2 diabetes by systematic review and meta-analysis. Methods PubMed, FSTA, Web of Science, CINAHEL, MEDLINE and Cochrane Library database of systematic review databases were searched using keywords (fasting blood glucose OR hemoglobin A1c OR HbA1c OR homeostasis) AND (Ginger or zingiber or “zingiber officinale” or “cinnamomum zeylanicum” or “cinnamomum aromaticum” or “cinnamomum cassia” or “cinnamomum verum” or curcumin or turmeric or curcuminoids or “curcuma longa” or langas or “curcuma zedoarias” or turmeric) AND (diabetes* OR “diabetes mellitus” OR “type 2” OR “blood glucose” OR insulin* OR antidiabet* OR “glucose level”) up to January 2020. Statistical calculations used SAS software version 9.2 (SAS, Cary NC, USA). P-values &lt; 0.05 were considered significant, P-values &lt; 0.10 were considered weakly significant. Results Twenty-three studies with 2237 trial participants were selected out of a 512 study pool. Spices decreased FBG and HbA1c %. The estimated reduction in intervention change vs. control change is as follows: A1c was −0.264 mg/dl, 95% CI (−0.5503, −0.02), P value 0.069; FBG was −9.9370 mg/dl, 95% CI (−20.79, 0.91), P value 0.07. A significant heterogeneity was observed overall among the all studies, indicating that not all studies had similar levels of decrease. Conclusions A correlation between consumption of certain common spices and significant reduction in glycemic indices among diabetes patients was proved. Funding Sources Clemson University.

scholarly journals Sodium-glucose co-transporter 2 inhibitors (SGLT2i); as a preventive factor of kidney failure in patients with type 2 diabetes; a meta-analysis of randomized controlled trials

2021 ◽  
Vol 10 (4) ◽  
pp. e35-e35
Author(s):  
Dorsa Jahangiri ◽  
Udit Narayan Padhi ◽  
Henu Kumar Verma ◽  
Bhaskar VKS Lakkakula ◽  
Rohollah Valizadeh ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Meta Analysis ◽  
Sglt2 Inhibitors ◽  
Renal Outcome ◽  
Diabetic Patients ◽  
Controlled Trials ◽  
Randomized Controlled

Introduction: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are a new class of anti-diabetic drugs. SGLT2 inhibitors lower blood glucose levels by decreasing glucose reabsorption in the proximal renal tubule, resulting in increased urinary glucose and sodium excretion. Objective: This study was conducted to investigate the effects of SGLT2i on individual renal outcomes in diabetic patients. Methods: This study was a systematic review and meta-analysis of clinical trials. A comprehensive search of Cochrane Central Register of Controlled Trials was conducted in the Cochrane Library and PubMed, to identify relevant articles focusing on SGLT2i and chronic kidney disease (CKD) in diabetic patients. The most recent article search was conducted on July 12, 2021. Results: Seven randomized controlled trials (RCTs) were included in the meta-analysis. Two trials were comparing dapagliflozin, two comparing empagliflozin, one comparing ertugliflozin, one comparing canagliflozin, and one comparing sotagliflozin. Composite renal outcome and acute kidney injury (AKI) was found in seven and four studies, respectively. Data on end-stage kidney disease (ESKD) and albuminuria or initiation of renal replacement therapy were reported in the two studies. The pooled risk ratio (RR) 95% confidence interval (CI) for the composite renal outcome was 0.54 (0.50–0.59), with 92 % heterogeneity. The pooled RR for AKI was 0.77 (0.66–0.89), with no heterogeneity. A significant lower incidence of albuminuria (RR: 0.69; 95% CI: 0.59–0.81), initiation of renal replacement therapy (RR: 0.71; 95% CI: 0.58–0.87), was observed following the use of SGLT2 inhibitors. Conclusion: Our findings confirm that the SGLT2 inhibitors can reduce the risk of albuminuria, AKI and renal replacement therapy in ESKD patients with T2D (type 2 diabetes). These meta-analyses provide substantial evidence supporting the beneficial effect of SGLT2 inhibitors on reducing CKD events in individuals with T2D.

scholarly journals Sodium-glucose co-transporter-2 inhibitors and the risk of major arrhythmias: a meta-analysis of the cardiovascular and renal outcome trials

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Boulmpou ◽  
D Patoulias ◽  
E Teperikidis ◽  
C E Papadopoulos ◽  
P Sarafidis ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Atrial Flutter ◽  
Atrioventricular Block ◽  
Meta Analysis ◽  
Renal Outcome ◽  
Diabetic Patients

Abstract Background Type 2 diabetes mellitus is closely associated with cardiovascular disease and evidence already exists on its arrhythmogenic action. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a unique class of oral antidiabetic medications which recently attracted attention for reducing the total risk of major adverse cardiovascular events in a series of recent, large placebo-controlled randomized clinical trials (RCTs). Dapagliflozin and empagliflozin additionally seem to improve survival and outcomes in patients with heart failure with reduced ejection fraction (HFrEF), irrespective of the presence of diabetes mellitus. Whether antidiabetic treatment with sodium-glucose co-transporter inhibitors could reduce the arrhythmic burden in diabetic patients still is to be clarified. Purpose The purpose of the present meta-analysis was to report the impact of SGLT2i on the risk for several types of cardiac arrhythmias, pooling data from all relevant cardiovascular and renal outcome, placebo-controlled, RCTs, comparing SGLT2i to placebo. Methods We searched PubMed for all available cardiovascular and renal outcome RCTs utilizing SGLT2i, along with grey literature sources. We sought to determine the risk of the following arrhythmias/cardiac disorders with the use of SGLT2i versus placebo: atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation, ventricular extrasystoles, sinus bradycardia, sinus node dysfunction, second degree atrioventricular block, complete atrioventricular block. Results We extracted relevant data from 8 trials (5 dedicated cardiovascular outcome trials, 2 dedicated renal outcome trials, 1 trial enrolling patients with HFrEF), pooling data in a total of 55,966 patients. SGLT-2i treatment compared to placebo produced a significant reduction in the risk of atrial fibrillation equal to 21% (RR=0.79, 95% CI: 0.67–0.93, I2=0%) (Figure 1). A non-significant reduction in the risk of atrial flutter equal to 9% (RR=0.91, 95% CI: 0.64–1.29, I2=0%) was also observed with SGLT2i (Figure 2). No significant effect on the rest major arrhythmias was observed. Conclusions Antidiabetic therapy with SGLT2i seems to hold a significant impact on antiarrhythmic burden in type 2 diabetes mellitus, reducing the risk of atrial fibrillation development. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

Sign in / Sign up

Export Citation Format

Share Document