A systematic review and meta-analysis evaluating sodium-glucose co-transporter 2 inhibitors (SGLT2-i) for type 2 diabetes included 34 double-blinded RCTs with 9 154 patients. Canagliflozin was administered 300 mg/day, dapagliflozin 10 mg/day, and empagliflozin 25 mg/day for at least 12 weeks. SGLT2-i reduced HbA1c compared with placebo: mean difference (MD) -0.69%, 95CI -0.75 to -0.62%. In 12 RCTs, there was no difference in HbA1c-reduction between SGLT2-i and metformin (MD -0.05%, 95% CI 0.21 to 0.12%), but a larger HbA1c reducing effect of SGLT2-i compared with sulphonylureas (MD -0.15%, 95% CI -0.21 to -0.08%) and dipeptidyl peptidase 4 inhibitors (DPP-4-i) (MD -0.25%, 955 CI -0.36 to -0.14%). Beneficial effects was found on bodyweight, blood pressure, lipids and alanine aminotransferase. There were no differences between SGLT2-i and placebo for serious adverse events. SGLT2-i increased the risk of urinary and genital tract infections and increased serum creatinine.
Another systematic review and meta-analysis evaluatede SGLT2-i for type 2 diabetes. SGLT2-i were compared with placebo in 45 studies (n=11 232) and with active comparators in 13 studies (n=5 175). They had a favorable effect on HbA1c (mean difference vs. placebo, -0.66%, 95% CI -0.73% to -0.58%; mean difference vs. active comparators was non-significant, -0.06%, 95% CI -0.18% to 0.05%). Compared with other agents, SGLT2-i reduced body weight (MD -1.80 kg, 95% CI -3.50 to -0.11 kg) and systolic blood pressure (MD -4.45 mm Hg, 95% CI -5.73 to -3.18 mm Hg). Urinary and genital tract infections were more common with SGLT2-i (odds ratios 1.42, 95% CI 1.06 to 1.90 and 5.06, 95% CI 3.44 to 7.45, respectively).
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Date of latest search: 2018-04-13