Key result
In a systematic review of 13 studies (N=3,849), pioglitazone, repaglinide, and alogliptin slowed carotid artery intima-media thickness progression, while rosiglitazone and SGLT-2 inhibitors did not.
Why the study?
The effect of oral hypoglycaemic agents on carotid artery intima-media thickness in patients with cardiovascular disease and/or diabetes remains uncertain despite known cardiovascular benefits of some agents.
Do oral hypoglycaemic agents reduce carotid artery intima-media thickness progression in adults with diabetes and/or cardiovascular disease?
Systematic Review (n=3,849)
Do oral hypoglycaemic agents reduce carotid artery intima-media thickness progression in adults with diabetes and/or cardiovascular disease?
Prolonged use of specific oral hypoglycaemic agents like pioglitazone, repaglinide, and alogliptin may slow CIMT progression, though efficacy varies significantly across different drug classes.
May support pioglitazone, repaglinide or alogliptin to slow CIMT progression in diabetes or CVD; leaves open need for hard-outcome trials.
INTRODUCTION: Atherosclerotic cardiovascular disease (ASCVD) is a global concern, with diabetes being a key risk factor. Preventive measures increasingly rely on surrogate markers, such as carotid artery intima-media thickness (CIMT), a marker linked to ASCVD. Given the connection between dysglycaemia and ASCVD, the impact of oral hypoglycaemic agents (OHA) on CIMT is of interest. Despite the cardiovascular benefits of several OHAs, their effect on CIMT remains uncertain. This review aims to clarify the influence of OHAs on CIMT in patients with ASCVD and/or diabetes. OBJECTIVES: This systematic review aims to assess the effect of OHAs on CIMT in patients with ASCVD and/or diabetes mellitus (Type 1 or Type 2). We aim to provide evidence on the role of OHAs in reducing cardiovascular events in these high-risk patients. METHODOLOGY: A systematic search of databases, including Cochrane, Embase, CINAHL, Scopus and PubMed, was conducted to identify relevant randomised controlled trials (RCTs). We analysed the efficacy and adverse effects of OHAs on CIMT in adults with diabetes and/or cardiovascular disease. RESULTS: The initial search identified 629 studies, with 13 selected, involving 3849 participants. Pioglitazone showed effectiveness in slowing CIMT progression in two out of three studies. Repaglinide was effective in reducing CIMT and inflammation, while Rosiglitazone showed no significant effect. Metformin, Sitagliptin and Alogliptin studies yielded mixed results, with some showing reduced CIMT progression but increased gastrointestinal and hypoglycaemia risks. SGLT-2 inhibitors Tofogliflozin and Ipragliflozin showed no significant CIMT reduction. CONCLUSION: The study suggests that prolonged use of Pioglitazone, Repaglinide and Alogliptin may significantly slow CIMT progression, improving cardiovascular risk management in patients with diabetes and/or cardiovascular disease. Further research is needed to understand the benefits and optimise oral hypoglycaemic treatment strategies for these patients.
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Shabu et al. (2025) conducted a systematic review in Cardiovascular disease and/or diabetes (n=3,849). Oral hypoglycaemic agents was evaluated on Carotid artery intima-media thickness (CIMT) progression. In a systematic review of 13 studies (N=3,849), pioglitazone, repaglinide, and alogliptin slowed carotid artery intima-media thickness progression, while rosiglitazone and SGLT-2 inhibitors did not.
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