Sodium glucose co-transporter 2 (SGLT2) inhibitors versus dipeptidyl peptidase-4 (DPP-4) inhibitors and the risk of Atrial Fibrillation in patients with type 2 diabetes mellitus: a meta-analysis

BACKGROUND: Several studies showed higher risks of cardiovascular complications to have been observed in patients with type 2 diabetes mellitus (T2DM). Atrial fibrillation (AF) and atrial flutter have been more pronounced in patients with hyperglycemia. Sodium-glucose co-transporter 2 (SGLT2) inhibitors are now considered as second-line treatment for patients with T2DM following inadequate glycemic control with first line agents. In this analysis, we aimed to compare the risk of AF in patients with T2DM who were treated with SGLT-2 inhibitors versus DPP-4 inhibitors. METHODS: Relevant publications comparing AF in patients with T2DM treated by SGLT-2 inhibitors versus DPP-4 inhibitors were searched through electronic databases. AF was the clinical endpoint in this analysis. Revman 5.4 software was used to carry out this analysis. Risk ratios (RR) with 95% confidence intervals (CIs) were used to assess the outcome. RESULTS: Eleven studies with a total number of 1,019,476 participants with T2DM were included in this analysis whereby 480,549 patients were assigned to SGLT-2 inhibitors and 538,927 patients were assigned to DPP-4 inhibitors. Result of this analysis showed SGLT-2 inhibitors to be associated with a significantly lower risk of AF compared to DPP-4 inhibitors in these patients with T2DM (RR: 0.57, 95% CI: 0.39 - 0.85; P = 0.006). CONCLUSIONS: Based on the result of this analysis, the risk of AF was significantly reduced with SGLT-2 inhibitors when compared to DPP-4 inhibitors in these patients with T2DM. This hypothesis should be confirmed in future larger studies.