Why the study?
Cardiovascular safety regarding heart failure among different classes of anti-diabetic treatments remained largely unknown.
Do different classes of anti-diabetic agents reduce incident heart failure or hospitalization for heart failure in individuals with type 2 diabetes?
Meta-Analysis (n=171,253)
Do different classes of anti-diabetic agents reduce incident heart failure or hospitalization for heart failure in individuals with type 2 diabetes?
Effect estimate: OR 0.68 (95% CI 0.59-0.78)
SGLT2 inhibitors are associated with the lowest risk of incident heart failure among all classes of anti-diabetic medications in patients with type 2 diabetes.
Supports preferring SGLT2 inhibitors in type 2 diabetes to reduce incident heart failure; confirms superiority versus other antidiabetic classes in network meta-analysis.
BACKGROUND: The cardiovascular (CV) safety in terms of heart failure among different classes of treatment remains largely unknown. We sought to assess the comparative effect of these agents on heart failure outcomes. METHODS: This study was registered in the International Prospective Register of Systematic Reviews (CRD 42016042063). MEDLINE, EMBASE, and the Cochrane Library Central Register of Controlled Trials were searched. For the primary outcomes reported previously, studies between Jan 1, 1980 and June 30, 2016 were screened, and subsequently updated till Jan 24, 2019. We performed network meta-analysis to obtain estimates for the outcomes of heart failure, in particular by rankograms for ranking of heart failure risk as well as by pairwise comparisons among all classes of anti-diabetic medications. RESULTS: A total of 91 trials were included, among which were 171,253 participants and 4163 reported cases of heart failure events. As for rankograms, the surface under the cumulative ranking curves (SUCRA) of sodium-glucose co-transporters 2 and thiazolidinediones were 93.4% and 4.3%, respectively, signifying the lowest and highest risk of heart failure, respectively. As for pairwise comparisons in the network, sodium-glucose co-transporters 2 were significantly superior to insulin (OR: 0.75, 95% CI 0.62-0.91), dipeptidyl peptidase 4 inhibitors (OR: 0.68, 95% CI 0.59-0.78), glucagon-like peptide-1 receptor agonists (OR: 0.65, 95% CI 0.54-0.78), and thiazolidinediones (OR: 0.46, 95% CI 0.27-0.77) in terms of heart failure risk. Furthermore, in an exploratory analysis among subjects with underlying heart failure or at risk of heart failure, the superiority of sodium-glucose co-transporters 2 was still significant. CONCLUSIONS: In terms of heart failure risk, sodium-glucose co-transporters 2 were the most favorable option among all classes of anti-diabetic medications.
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Yang et al. (2019) conducted a meta-analysis in Type 2 diabetes (n=171,253). Sodium-glucose co-transporter 2 inhibitors (SGLT2i) vs. Other anti-diabetic agents (Insulin, DPP4i, GLP1a, TZD, MET, SU) and placebo was evaluated on Incident heart failure or hospitalization for heart failure (OR 0.68, 95% CI 0.59-0.78).
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