Newer Pharmacologic Treatments in Adults With Type 2 Diabetes: A Systematic Review and Network Meta-analysis for the American College of Physicians
Authors' conclusion
In adults with T2DM, SGLT2 inhibitors and GLP1 agonists (but not DPP4 inhibitors, insulin, or tirzepatide) reduce all-cause mortality and MACE compared with usual care. SGLT2 inhibitors reduce CKD progression and heart failure hospitalization and GLP1 agonists reduce stroke compared with usual care. Serious adverse events and severe hypoglycemia are less frequent with SGLT2 inhibitors and GLP1 agonists than with insulin or SU.
Study context
- Population
- Adults with T2D in randomized controlled trials (RCTs) lasting ≥52 weeks with ≥500 participants, published 2010 to January 202384 RCTs · 130 publications
- Comparison
- SGLT2i, GLP-1 RA, DPP-4i, long-acting insulins (and tirzepatide, sulfonylurea (SU)) vs usual care and each other
- Outcome
- All-cause mortality and MACE vs usual care
Methodological detailsGRADE certainty of evidence, dual independent risk-of-bias assessment
- GRADE certainty of evidence
- Dual independent risk-of-bias assessment
Pooled result
As reported in the abstract
- SGLT2i and GLP-1 RA reduce all-cause mortality vs usual care (high certainty of evidence (CoE))
- SGLT2i and GLP-1 RA reduce major adverse cardiovascular events (MACE) vs usual care (moderate to high CoE)
- Insulin, tirzepatide and DPP-4i do not reduce all-cause mortality vs usual care (low to high CoE)
- Predefined minimally important difference threshold not met for these outcomes
Further pooled results
Chronic kidney disease (CKD) progression, HF hospitalization and stroke vs usual care
- SGLT2i reduce CKD progression and HF hospitalizations; GLP-1 RA reduce stroke (high CoE)
All-cause mortality: head-to-head comparisons
- SGLT2i and GLP-1 RA reduce all-cause mortality vs insulin (low to moderate CoE)
- GLP-1 RA reduce all-cause mortality vs DPP-4i (moderate CoE)
MACE: head-to-head comparisons
- SGLT2i reduce MACE vs DPP-4i and SU (moderate to high CoE)
Safety
- SGLT2i reduce serious adverse events and severe hypoglycemia vs usual care (high CoE)
- SGLT2i and GLP-1 RA reduce severe hypoglycemia vs SU and insulin (low to high CoE)
Original publication
Newer Pharmacologic Treatments in Adults With Type 2 Diabetes: A Systematic Review and Network Meta-analysis for the American College of Physicians. Ann Intern Med. Published 19 April 2024. doi:10.
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