TY - JOUR
T1 - Sodium-glucose cotransporter 2 (SGLT-2) inhibitors and microvascular outcomes in patients with type 2 diabetes
T2 - systematic review and meta-analysis
AU - Dorsey-Treviño, E. G.
AU - González-González, J. G.
AU - Alvarez-Villalobos, N.
AU - González-Nava, V.
AU - Contreras-Garza, B. M.
AU - Díaz González-Colmenero, A.
AU - Rodríguez-Tamez, G.
AU - Barrera-Flores, F. J.
AU - Farrell, A. M.
AU - Montori, V. M.
AU - Rodriguez-Gutierrez, R.
N1 - Funding Information:
No grant, funding source, or any other kind of financial support was received for the elaboration of this study. Acknowledgements
Publisher Copyright:
© 2019, Italian Society of Endocrinology (SIE).
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Purpose: The effect of the sodium-glucose 2 (SGLT-2) inhibitors on microvascular complications remains uncertain. We performed a systematic review to determine the efficacy of the SGLT-2 inhibitors on microvascular outcomes in patients with type 2 diabetes. Methods: A comprehensive search was performed using Ovid, MEDLINE, EMBASE, Web of Science, and Scopus from inception to May 2019. Randomized trials comparing SGLT-2 inhibitors with placebo or other medication for type 2 diabetes for ≥ 4 weeks were included. Diabetes-related microvascular complications such as nephropathy, retinopathy, neuropathy, and peripheral vascular disease were evaluated. A random-effect model using mean differences for continuous outcomes and risk ratio for dichotomous outcomes was used to synthesize data. PROSPERO (CRD 42017076460). Results: A total of 40 RCTs with overall moderate quality of evidence were included. SGLT-2 inhibitors reduced the risk of renal-replacement therapy (0.65; 95% CI 0.54–0.79), renal death (0.57; 95% CI 0.49–0.65), and progression of albuminuria (0.69; 95% CI 0.66–0.73). Conversely, they appeared ineffective in maintaining eGFR (0.33; 95% CI − 0.74 to 1.41) or reducing serum creatinine (− 0.07; 95% CI − 0.26 to 0.11), whereas urine albumin–creatinine ratio (− 23.4; 95% CI − 44.6 to − 2.2) was reduced. Risk of amputation was non-significant (1.30; 95% CI 0.93–1.83). No available data were found regarding neuropathy and retinopathy to perform a quantitative analysis. Conclusion: SGLT-2 inhibitors may reduce the risk of renal patient-important outcomes but fail to improve surrogate outcomes. Apparently, no increased risk of amputations was observed with these medications. No data were available regarding other microvascular complications.
AB - Purpose: The effect of the sodium-glucose 2 (SGLT-2) inhibitors on microvascular complications remains uncertain. We performed a systematic review to determine the efficacy of the SGLT-2 inhibitors on microvascular outcomes in patients with type 2 diabetes. Methods: A comprehensive search was performed using Ovid, MEDLINE, EMBASE, Web of Science, and Scopus from inception to May 2019. Randomized trials comparing SGLT-2 inhibitors with placebo or other medication for type 2 diabetes for ≥ 4 weeks were included. Diabetes-related microvascular complications such as nephropathy, retinopathy, neuropathy, and peripheral vascular disease were evaluated. A random-effect model using mean differences for continuous outcomes and risk ratio for dichotomous outcomes was used to synthesize data. PROSPERO (CRD 42017076460). Results: A total of 40 RCTs with overall moderate quality of evidence were included. SGLT-2 inhibitors reduced the risk of renal-replacement therapy (0.65; 95% CI 0.54–0.79), renal death (0.57; 95% CI 0.49–0.65), and progression of albuminuria (0.69; 95% CI 0.66–0.73). Conversely, they appeared ineffective in maintaining eGFR (0.33; 95% CI − 0.74 to 1.41) or reducing serum creatinine (− 0.07; 95% CI − 0.26 to 0.11), whereas urine albumin–creatinine ratio (− 23.4; 95% CI − 44.6 to − 2.2) was reduced. Risk of amputation was non-significant (1.30; 95% CI 0.93–1.83). No available data were found regarding neuropathy and retinopathy to perform a quantitative analysis. Conclusion: SGLT-2 inhibitors may reduce the risk of renal patient-important outcomes but fail to improve surrogate outcomes. Apparently, no increased risk of amputations was observed with these medications. No data were available regarding other microvascular complications.
KW - Meta-analysis
KW - Microvascular complications
KW - Sodium-glucose cotransporter 2 inhibitors
KW - Systematic review
KW - Type 2 diabetes mellitus
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U2 - 10.1007/s40618-019-01103-9
DO - 10.1007/s40618-019-01103-9
M3 - Article
C2 - 31489568
AN - SCOPUS:85073776386
VL - 43
SP - 289
EP - 304
JO - Journal of Endocrinological Investigation
JF - Journal of Endocrinological Investigation
SN - 0391-4097
IS - 3
ER -