scholarly journals Network Meta-Analysis of Novel Glucose-Lowering Drugs on Risk of Acute Kidney Injury

2020 ◽  
Vol 16 (1) ◽  
pp. 70-78 ◽  
Author(s):  
Min Zhao ◽  
Shusen Sun ◽  
Zhenguang Huang ◽  
Tiansheng Wang ◽  
Huilin Tang
Keyword(s):  
Type 2 Diabetes ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Lower Risk ◽  
Meta Analysis ◽  
Secondary Analysis ◽  
Sglt2 Inhibitors ◽  
Glucose Lowering ◽  
Event Driven

Background and objectivesLittle is known about the comparative effects of dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), or sodium glucose cotransporter-2 (SGLT2) inhibitors on risk of AKI. This study aimed to compare the effects of these three novel classes of glucose-lowering drugs on AKI risk in patients with or without type 2 diabetes, by network meta-analysis of event-driven cardiovascular or kidney outcome trials.Design, setting, participants, & measurementsWe systematically searched electronic databases up to September 2020, and included 20 event-driven cardiovascular or kidney outcome trials (18 trials included patients with type 2 diabetes only, and two trials included patients with or without type 2 diabetes). A network meta-analysis using a frequentist approach was performed to compare the effects of DPP-4 inhibitors, GLP-1RAs, or SGLT2 inhibitors on risk of AKI, and estimate the probability for each intervention as the safest one. The primary analysis included 18 trials with type 2 diabetes only, and a secondary analysis included 20 trials.ResultsIn the 18 trials with a total of 2051 AKI events (range: 1–300) among 156,690 patients with type 2 diabetes only, our network meta-analysis showed that SGLT2 inhibitors were associated with a lower risk of AKI compared with placebo (odds ratio, 0.76; 95% confidence interval, 0.66 to 0.88), whereas both DPP-4 inhibitors and GLP-1RAs had neutral effects on risk of AKI. Moreover, SGLT2 inhibitors were significantly associated with a lower risk in AKI than both GLP-1RAs (odds ratio, 0.79; 95% confidence interval, 0.65 to 0.97) and DPP-4 inhibitors (odds ratio, 0.68; 95% confidence interval, 0.54 to 0.86). SGLT2 inhibitors have the highest probability of being the safest intervention (84%). The results were similar in the secondary analysis.ConclusionsCurrent evidence indicates that SGLT2 inhibitors have a lower risk of AKI than both DPP-4 inhibitors and GLP-1RAs.

Novel glucose lowering agents are associated with a lower risk of cardiovascular and adverse events in type 2 diabetes: A population based analysis

2020 ◽  
Vol 310 ◽  
pp. 147-154 ◽  
Author(s):  
Malik Elharram ◽  
Cristiano S. Moura ◽  
Michal Abrahamowicz ◽  
Sasha Bernatsky ◽  
Hassan Behlouli ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Adverse Events ◽  
Lower Risk ◽  
Population Based ◽  
Glucose Lowering

scholarly journals Meta-Analysis of the Relationship Between Ethnicity, Obesity, and Type 2 Diabetes of Adults in Urban Populations of Central America

2016 ◽  
Vol 5 (3) ◽  
pp. 274
Author(s):  
William G Wuenstel ◽  
James A. Johnson ◽  
James Humphries ◽  
Cheryl Samuel
Keyword(s):  
Type 2 Diabetes ◽  
Relative Risk ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Central American ◽  
Significance Level ◽  
Study Participants ◽  
The Impact ◽  
The Relationship

<table width="593" border="1" cellspacing="0" cellpadding="0"><tbody><tr><td rowspan="2" valign="top" width="387">The purpose of this meta-analysis was to examine the impact of ethnicity and obesity as it relates to Type-2 Diabetes (T2D) in specific Central American countries. A meta-analysis was conducted to determine the association of ethnicity, obesity, and T2D.  Four studies that qualified for inclusion were identified by searching MEDLINE and PubMed databases. The studies on the association of ethnicity and T2D had a combined population resulted in 265,858 study participants. Two studies on the association of obesity and T2D had 197,899 participants. An analysis of the data was conducted utilizing the relative risk ration, odds ratio, and forest plots. The comparison of the relative risk of T2D across ethnic categories by studies range for Blacks was 1.59 to 2.74, Asians was 1.43 to 2.08, and Hispanics .92 to 2.91.  The ethnic difference in the prevalence of diabetes was almost two-fold higher in all ethnic groups than among the Caucasians with a significance level of 95%. A comparison of relative risk of T2D across weight categories was significantly higher among those with a diagnosed of diabetes in all reported areas. The odds ratio was very close to the risk ratio in both ethnicity and obesity to the development of T2D. The meta-analysis findings documented that an association does exist between ethnicity and obesity to the development of type 2 diabetes.</td><td width="0" height="85"> </td></tr><tr><td width="0" height="82"> </td></tr></tbody></table>

scholarly journals Comparative effects of sodium glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP4) inhibitors on new-onset atrial fibrillation and stroke outcomes

2021 ◽  
Author(s):  
Sharen Lee ◽  
Jiandong Zhou ◽  
Carlin Chang ◽  
Tong Liu ◽  
Dong Chang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Propensity Score ◽  
Lower Risk ◽  
Sglt2 Inhibitors ◽  
All Cause Mortality ◽  
New Onset

AbstractBackgroundSGLT2I and DPP4I are medications prescribed for type 2 diabetes mellitus patients. However, there are few population-based studies comparing their effects on incident atrial fibrillation or ischemic stroke.MethodsThis was a territory-wide cohort study of type 2 diabetes mellitus patients prescribed SGLT2I or DPP4I between January 1st, 2015 to December 31st, 2019 in Hong Kong. Patients with both DPP4I and SGLT2I use and patients with drug discontinuation were excluded. Patients with prior AF or stroke were excluded for the respective analysis. 1:2 propensity-score matching was conducted for demographics, past comorbidities and medications using nearest-neighbor matching method. Cox models were used to identify significant predictors for new onset heart failure (HF) or myocardial infarction (MI), cardiovascular and all-cause mortality.ResultsThe AF-free cohort included 49108 patients (mean age: 66.48 years old [SD: 12.89], 55.32% males) and the stroke-free cohort included 49563 patients (27244 males [54.96%], mean baseline age: 66.7 years old [SD: 12.97, max: 104.6 years old]). After propensity score matching, SGLT2i use was associated with a lower risk of new onset AF (HR: 0.43[0.28, 0.66]), cardiovascular mortality (HR: 0.79[0.58, 1.09]) and all-cause mortality (HR: 0.69[0.60, 0.79]) in the AF-free cohort. It was also associated with a lower risk of new onset stroke (0.46[0.33, 0.64]), cardiovascular mortality (HR: 0.74[0.55, 1.00]) and all-cause mortality (HR: 0.64[0.56, 0.74]) in the stroke-free cohort.ConclusionsThe novelty of our work si that SGLT2 inhibitors are protective against atrial fibrillation and stroke development for the first time. These findings should be validated in other cohorts.

Do reductions in risk of cardiorenal events with SGLT2 inhibitors in type 2 diabetes vary with baseline characteristics? A meta-analysis

Endocrine ◽  
2020 ◽  
Vol 69 (3) ◽  
pp. 688-691
Author(s):  
Mei Qiu ◽  
Shu-Yan Liu ◽  
Jin-Song Gu ◽  
Kai-Kai Li ◽  
Ling-Lin Li ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Meta Analysis ◽  
Sglt2 Inhibitors ◽  
Baseline Characteristics

scholarly journals Hypoglycemia in People with Type 2 Diabetes and CKD

2019 ◽  
Vol 14 (6) ◽  
pp. 844-853 ◽  
Author(s):  
Iram Ahmad ◽  
Leila R. Zelnick ◽  
Zona Batacchi ◽  
Nicole Robinson ◽  
Ashveena Dighe ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Confidence Interval ◽  
Hemoglobin A1c ◽  
Glucose Monitoring ◽  
Continuous Glucose Monitor ◽  
Glucose Lowering ◽  
Level 1 ◽  
Glucose Management ◽  
Level 2

Background and objectivesAmong people with diabetes mellitus, CKD may promote hypoglycemia through altered clearance of glucose-lowering medications, decreased kidney gluconeogenesis, and blunted counter-regulatory response. We conducted a prospective observational study of hypoglycemia among 105 individuals with type 2 diabetes treated with insulin or a sulfonylurea using continuous glucose monitors.Design, setting, participants & measurementsWe enrolled 81 participants with CKD, defined as eGFR<60 ml/min per 1.73 m2, and 24 control participants with eGFR≥60 ml/min per 1.73 m2 frequency-matched on age, duration of diabetes, hemoglobin A1c, and glucose-lowering medications. Each participant wore a continuous glucose monitor for two 6-day periods. We examined rates of sustained level 1 hypoglycemia (<70 mg/dl) and level 2 hypoglycemia (<54 mg/dl) among participants with CKD. We then tested differences compared with control participants as well as a second control population (n=73) using Poisson and linear regression, adjusting for age, sex, and race.ResultsOver 890 total days of continuous glucose monitoring, participants with CKD were observed to have 255 episodes of level 1 hypoglycemia, of which 68 episodes reached level 2 hypoglycemia. Median rate of hypoglycemic episodes was 5.3 (interquartile range, 0.0–11.7) per 30 days and mean time spent in hypoglycemia was 28 (SD 37) minutes per day. Hemoglobin A1c and the glucose management indicator were the main clinical correlates of time in hypoglycemia (adjusted differences 6 [95% confidence interval, 2 to 10] and 13 [95% confidence interval, 7 to 20] fewer minutes per day per 1% higher hemoglobin A1c or glucose management indicator, respectively). Compared with control populations, participants with CKD were not observed to have significant differences in time in hypoglycemia (adjusted differences 4 [95% confidence interval, −12 to 20] and −12 [95% confidence interval, −29 to 5] minutes per day).ConclusionsAmong people with type 2 diabetes and moderate to severe CKD, hypoglycemia was common, particularly with tighter glycemic control, but not significantly different from groups with similar clinical characteristics and preserved eGFR.

scholarly journals Genetic variation in TCF7L2 rs7903146 correlating with peripheral arterial disease in long-standing type 2 diabetes

2019 ◽  
Vol 17 (1) ◽  
pp. 147916411988847 ◽  
Author(s):  
Eu Jeong Ku ◽  
Gun Woo Won ◽  
Yong Hee Lee ◽  
Dong-Hwa Lee ◽  
Hyun Jeong Jeon ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Genetic Variation ◽  
Confidence Interval ◽  
Peripheral Arterial Disease ◽  
Odds Ratio ◽  
Arterial Disease ◽  
Multivariate Logistic Regression Model ◽  
Peripheral Arterial ◽  
Tcf7l2 Rs7903146

Aim: The aim of this study was to investigate the association between the transcription factor 7-like 2 gene ( TCF7L2) rs7903146 polymorphism and peripheral arterial disease in type 2 diabetes. Methods: In total, 1818 Korean type 2 diabetes patients were enrolled from January 2013 to December 2017. Subjects were categorized into two groups according to their duration of type 2 diabetes: long (⩾10 years, n = 771) and short (<10 years, n = 1047) durations. A multivariate logistic regression model was used for assuming an additive effect on peripheral arterial disease for the presence of a variant allele in TCF7L2 rs7903146. Results: The frequency of the minor T-allele was 7.6% ( n = 139), and this allele was significantly associated with a 2.6-fold higher risk of peripheral arterial disease (odds ratio = 2.595, 95% confidence interval = 1.177–5.722, p = 0.018) in patients exhibiting a long duration of type 2 diabetes (⩾10 years). This result was significant after adjusting for age, sex, body mass index, familial history of diabetes, smoking, duration of diabetes and laboratory measurements, which included glycated haemoglobin, fasting plasma glucose and lipid profiles. In patients with diabetes < 10 years, there was no significant association between TCF7L2 rs7903146 and peripheral arterial disease (odds ratio = 1.233, 95% confidence interval = 0.492–3.093, p = 0.655). Conclusion: Our results provide evidence that genetic variation in TCF7L2 rs7903146 could increase risk for peripheral arterial disease in patients exhibiting long-standing type 2 diabetes.

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