Efficacy and safety of sodium glucose cotransporter 2 inhibitors plus standard care in diabetic kidney disease: A systematic review and meta-analysis.

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  • Additional Information
    • Source:
      Publisher: Elsevier Science Pub. Co Country of Publication: United States NLM ID: 9204583 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-460X (Electronic) Linking ISSN: 10568727 NLM ISO Abbreviation: J Diabetes Complications Subsets: MEDLINE
    • Publication Information:
      Original Publication: New York, NY : Elsevier Science Pub. Co., c1992-
    • Subject Terms:
      Diabetic Nephropathies*/drug therapy ; Diabetic Nephropathies*/complications ; Diabetes Mellitus, Type 2*/complications ; Diabetes Mellitus, Type 2*/drug therapy ; Sodium-Glucose Transporter 2 Inhibitors*/adverse effects ; Kidney Failure, Chronic*/complications; Humans ; Glycated Hemoglobin ; Angiotensin Receptor Antagonists/adverse effects ; Angiotensin-Converting Enzyme Inhibitors/adverse effects
    • Abstract:
      Introduction: Many people with type 2 diabetes progress to end-stage diabetic kidney disease (DKD) despite blockade of the renin-angiotensin system, suggesting the need for innovative treatment options for DKD. To capture the findings of recent studies, we performed an updated systematic review and meta-analysis of the efficacy and safety of sodium glucose co-transporter 2 (SGLT2) inhibitors combined with standard care involving angiotensin converting enzyme (ACE) inhibitors and/or angiotensin receptor blockers (ARBs) on the development and progression of DKD in people with type 2 diabetes compared with standard care alone.
      Methods: The Cochrane Library, MEDLINE, EMBASE, PubMed and clinical trials registers were systematically searched for randomized controlled trials published before 1 September 2022. Primary outcomes were urine albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR). Secondary outcomes were glycated hemoglobin (HbA1c) and systolic blood pressure (SBP). Relative risk was calculated for adverse events.
      Results: Eight studies enrolling 5512 participants were included. In the meta-analysis (n = 1327), SGLT2 inhibitors were associated with a statistically significant reduction in UACR (weighted mean difference [WMD] -105.61 mg/g, 95 % CI -197.25 to -13.98, I 2  = 99 %, p = 0.02). There was no statistically significant difference in relation to eGFR (n = 1375; WMD -0.23 mL/min/1.73m 2 , 95 % CI -4.34 to 3.89, I 2  = 94 %, p = 0.91).
      Conclusions: SGLT2 inhibitors in addition to standard care including ACE inhibitors and/or ARBs significantly reduced albuminuria, HbA1c and SBP when compared to standard care alone, supporting their routine use in people with type 2 diabetes.
      Competing Interests: Conflict of interest statement MPS has received research support from Boehringer-Ingelheim, Medtronic, Abbott, Novartis, Servier, Pfizer, and consulting/lecture fees from Medtronic and Abbott. The authors declare there are no conflicts of interest.
      (Copyright © 2023 Elsevier Inc. All rights reserved.)
    • Contributed Indexing:
      Keywords: ACE inhibitors; ARBs; Diabetic kidney disease; SGLT2 inhibitors; Type 2 diabetes; Urine albumin-creatinine ratio
    • Accession Number:
      0 (Sodium-Glucose Transporter 2 Inhibitors)
      0 (Glycated Hemoglobin)
      0 (Angiotensin Receptor Antagonists)
      0 (Angiotensin-Converting Enzyme Inhibitors)
    • Publication Date:
      Date Created: 20230501 Date Completed: 20230522 Latest Revision: 20230613
    • Publication Date:
      20240628
    • Accession Number:
      10.1016/j.jdiacomp.2023.108456
    • Accession Number:
      37127001