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:
We would like to thank the Research Unit from the School of Medicine of the Universidad Autonoma de Nuevo Leon, Monterrey, Mexico and the Knowledge and Evaluation Research (KER) Unit from the Mayo Clinic, Rochester, MN for their support and guidance in the conduct of this systematic review.
Publisher Copyright:
© 2019, Italian Society of Endocrinology (SIE).
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
UR - http://www.scopus.com/inward/record.url?scp=85073776386&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85073776386&partnerID=8YFLogxK
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 -