Effects of glucose‐lowering agents on cardiovascular and renal outcomes in subjects with type 2 diabetes: An updated meta‐analysis of randomized controlled trials with external adjudication of events
Authors' conclusion
The results of this updated meta-analysis need to be considered in the choice of drug treatment for type 2 diabetes mellitus, which cannot be merely based on the effect of glucose-lowering drugs on long-term glycaemic control.
Study context
- Population
- Adults with T2D; RCTs published up to 28 February 2022 (MEDLINE, EMBASE)group n = number of RCTs
- Comparison
- Glucose-lowering drug classes vs placebo or active comparators
- Metforminn = 17
- Pioglitazonen = 20
- Alpha-glucosidase inhibitorsn = 9
- Insulin secretagoguesn = 42
- Dipeptidyl-peptidase-4 inhibitorsn = 67
- Glucagon-like peptide-1 receptor agonistsn = 45
- SGLT-2in = 42
- Insulinn = 18
- Outcome
- Principal outcomes: all-cause mortality, 3-point MACE, hospitalization for HF (hospitalization for heart failure (HHF))
Methodological detailsonly trials with formal external adjudication of events, follow-up ≥52 weeks, placebo or active comparators
- Only trials with formal external adjudication of events
- Follow-up ≥52 weeks
- Placebo or active comparators
Pooled result
As reported in the abstract
All-cause mortality, MACE, HHF
Each group vs placebo or active comparatorsEstimate (95% CI)
GLP-1 RA
MH-OR, all-cause mortality 0.88(0.83–0.95)
SGLT-2i
MH-OR, all-cause mortality 0.85(0.79–0.91)
GLP-1 RA
MH-OR, MACE 0.89(0.84–0.94)
SGLT-2i
MH-OR, MACE 0.90(0.84–0.96)
SGLT-2i
MH-OR, HHF 0.68(0.62–0.75)
Metformin
MH-OR, MACE 0.60(0.47–0.80)
Pioglitazone
MH-OR, MACE 0.85(0.74–0.97)
Pioglitazone
MH-OR, HHF 1.30(1.04–1.62)
Insulin secretagogues
MH-OR, all-cause mortality 1.12(1.01–1.24)
Insulin secretagogues
MH-OR, MACE 1.19(1.02–1.39)
Further pooled results
| Outcome | MH-OR (CI) | |
|---|---|---|
| Worsening albuminuriaSGLT-2ivs Placebo or active comparators | 0.67 (0.55–0.80) | |
| Doubling of serum creatinineSGLT-2ivs Placebo or active comparators | 0.58 (0.44–0.79) | |
| 0.512MH-OR (log scale) |
Original publication
Effects of glucose‐lowering agents on cardiovascular and renal outcomes in subjects with type 2 diabetes: An updated meta‐analysis of randomized controlled trials with external adjudication of events. Diabetes Obes Metab. Published 24 October 2022. doi:10.
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