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- Title
Sodium-glucose co-transporter inhibitors in insulin-treated diabetes: a meta-analysis.
- Authors
Pedro Ferreira, João; Cristina Oliveira, Ana; Saraiva, Francisca A.; Vasques-Nóvoa, Francisco; Leite-Moreira, Adelino
- Abstract
Background: Patients with insulin-treated type 2 diabetes (T2D) have a hi gh risk of major adverse cardiovascular events. Sodium-glucose cotransporter inhibitors (SGLTi) improve outcomes without hypoglycaemic risk. Aims: To study the effect of SGLTi in patients with T2D with and wit hout background insulin treatment in outcomedriven RCTs. Methods: Random effects models. Results: A total of 54 374 patients with T2D were included in the anal ysis, of which 26 551 (48.8%) were treated with insulin. For 3P-MACE in patients without insulin treatment, the HR (95% CI) for the effect of SGLTi vs placebo was 0.93 (0.81-1.05), with moderate heterogeneity (I2 = 49.2%, Q statistic P = 0.11). In insulin-treated patients, the HR (95% CI) was 0.88 (0.82-0.95), without evidence of heterogeneity (I 2 =0.0%, Q statistic P =0.91). The pooled effect evidenced a 10% reduction of 3P-MACE with SGLTi (HR: 0.90, 95% CI: 0.85-0 .96), without SGLTi-by-insulin interaction P = 0.53. For the composite outcome of HF hospitalisation or cardiovascul ar death in patients without insulin treatment, the HR (95% CI) for the effect of SGLTi vs placebo was 0.77 (0.61-0. 92), with marked heterogeneity (I2 = 66.8%, Q statistic P = 0.02). In insulin-treated patients, the HR (95% CI) was 0.77 (0.68-0.86), without significant heterogeneity (I2 = 31.7%, Q statistic P = 0.25). The pooled effect evidenced a 23% reduction of HF hospit alisations or cardiovascular death with SGLTi (HR: 0.77, 95% CI: 0.68-0.85), without SGLTi-by-insulin i nteraction P = 0.98. Conclusion: SGLTi reduces cardiovascular events regardless of insulin use. However, the treatment effect is more homogeneous among insulin-treated patients, supporting the use of SGLTi for the treatment of patients with T2D requiring insulin for glycaemic control.
- Subjects
EMPAGLIFLOZIN; DIABETES; RANDOM effects model; GLYCEMIC control; TYPE 2 diabetes; CARDIOVASCULAR disease related mortality
- Publication
European Journal of Endocrinology, 2021, Vol 184, Issue 6, p783
- ISSN
0804-4643
- Publication type
Article
- DOI
10.1530/EJE-20-1484