What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Type 2 Diabetes (n=868). Intervention: SGLT-2 inhibitors vs. Control (metformin, sulfonylureas, GLP-1, placebo). Primary outcome: Flow-mediated dilation (FMD) (SMD 0.18, 95% CI 0.02-0.34, p=0.03).

February 16, 2022Frontiers in Endocrinology62 citationsOpen Access

Effects of SGLT-2 Inhibitors on Vascular Endothelial Function and Arterial Stiffness in Subjects With Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

RWRan Wei WWWeihao Wang QPQi Pan

Key Result

SGLT-2 inhibitors significantly improved flow-mediated dilation compared to control groups in patients with type 2 diabetes (SMD 0.18), but had no significant effect on pulse wave velocity.

Study Design

Type

Meta-Analysis (n=868)

Structured PICO

Do SGLT-2 inhibitors improve vascular endothelial function and arterial stiffness in patients with type 2 diabetes?

Population

868 patients with type 2 diabetes from 9 randomized controlled trials and 2 cohort studies evaluating the effects of SGLT-2 inhibitors on endothelial function and arterial stiffness.

Intervention

SGLT-2 inhibitors

Comparator

Control group (other antidiabetic agents or placebo)

Outcome

Vascular endothelial function (measured by flow-mediated dilation [FMD]) and arterial stiffness (measured by pulse wave velocity [PWV])surrogate

SGLT-2 inhibitors significantly improve arterial endothelial function (FMD) in patients with type 2 diabetes, though they do not significantly affect arterial stiffness (PWV).

Main Result

Standardized Mean Difference: 0.18 (95% CI 0.02–0.34)

p-value: p=0.03

Limitations

Only retrieved articles published in English, with the possibility of selection bias
Poorly controlled heterogeneity in the experiment
PWV data types (ba-PWV or cf-PWV) are different
FMD data types varied (FMD 1 min vs peak FMD)
Some literature was not included due to the lack of PWV and FMD values and incomplete data, resulting in selection bias
The follow-up period for different studies was also different

Abstract

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the effects of SGLT-2 inhibitors (SGLT-2i) on endothelial function and arteriosclerosis in diabetic patients. METHODS: Randomized controlled trials (RCTs) were retrieved from PubMed, Embase, Cochrane Library, and Web of Science databases to evaluate the effects of SGLT-2i on endothelial function and atherosclerosis in type 2 diabetic patients. RESULTS: We selected 9 RCTs and 2 cohort studys involving 868 patients. Of these, six studies provided flow-mediated dilation (FMD) levels before and after the intervention. The pooled analysis showed that SGLT-2i could significantly improve the FMD compared to the control group (SMD: 0.18, 95% CI: 0.02 ~ 0.34, P = 0.03). Three studies provided the change in FMD before and after the intervention. Pooled analysis showed no significant differences in FMD change between the SGLT-2i group and the control group. (MD: 2.1, 95%-CI: -0.11~4.31, P = 0.06). Five studies showed pulse wave velocity (PWV) results. Pooled analysis showed no significant differences in the change in PWV between the SGLT-2i group and the control group (SMD: 0.11, 95%-CI: - 0.15 ~ 0.37, P = 0.4). CONCLUSIONS: The ability of SGLT-2 inhibitors to improve FMD was significant, but there was no significant effect on PWV levels. SGLT-2i was superior to other antidiabetic agents in improving arterial endothelial function.

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