Effectiveness of different anti-diabetic medications in managing cardiovascular outcomes in patients with type 2 diabetes: A meta-analysis
DOI:
https://doi.org/10.48047/HM.10.2.2024.1102-1115Keywords:
Type 2 diabetes, anti-diabetic medications, cardiovascular outcomes, metaanalysis, SGLT-2 inhibitors, GLP-1 receptor agonistsAbstract
Background: Type 2 diabetes is a prevalent metabolic disorder associated with an increased risk of cardiovascular complications. Managing these cardiovascular outcomes is critical, and various anti-diabetic medications are used for this purpose. This meta-analysis aims to assess the effectiveness of different anti-diabetic drugs in reducing cardiovascular risks in patients with type 2 diabetes.
Methods: A meta-analysis was conducted using data from 850 patients diagnosed with type 2 diabetes. The study included randomized controlled trials (RCTs) and cohort studies comparing the impact of different classes of anti-diabetic medications, such as SGLT-2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors, on cardiovascular outcomes. The primary outcomes were major adverse cardiovascular events (MACE), including heart attack, stroke, and cardiovascular death.
Results: The pooled data indicated that SGLT-2 inhibitors and GLP-1 receptor agonists showed a significant reduction in MACE compared to other anti-diabetic medications. SGLT- 2 inhibitors were associated with a 25% reduction in heart failure hospitalization, while GLP- 1 receptor agonists were linked to a 15% decrease in stroke incidence. DPP-4 inhibitors had no significant impact on cardiovascular outcomes.
Conclusion: The analysis suggests that SGLT-2 inhibitors and GLP-1 receptor agonists are more effective in managing cardiovascular outcomes in patients with type 2 diabetes compared to DPP-4 inhibitors. These findings support the preferential use of these medications for cardiovascular risk reduction in this patient population.
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References
Aldossari, K. K. (2018). Cardiovascular outcomes and safety with antidiabetic drugs.
International Journal of Health Sciences, 12(5), 70-83.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124835/
Bahijri SM, Jambi HA, Al Raddadi RM, Ferns G, Tuomilehto J. The prevalence of
diabetes and prediabetes in the adult population of Jeddah, Saudi Arabia–a communitybased survey. PLoS One. 2016;11
. [PMC free article]
Robert AA, Al Dawish MA, Braham R, Musallam MA, Al Hayek AA, Al Kahtany NH,
et al. Type 2 diabetes mellitus in Saudi Arabia: Major challenges and possible solutions.
Curr Diabetes Rev. 2017;13:59–64.
WHO. Definition, Diagnosis and Classification of Diabetes Mellitus and its
Complications. Dept. of Noncommunicable Disease Surveillance: WHO. 1999. [[Last
accessed on 2017 Jul 30]]. Available from:
http://www.apps.who.int/iris/bitstream/10665/66040/1/WHO_NCD_NCS_99.2.pdf.uc
d4r4.
National Institute for Health and Care Excellence. Type 2 diabetes in Adults:
Management of type 2 Diabetes in Adults. 2015. [[Last accessed 0n 2017 Jul 30]].
Available from: http://www.tinyurl.com/jucd4r4.
British Cardiac Society, British Hypertension Society, Diabetes UK, HEART UK,
Primary Care Cardiovascular Society, Stroke Association. et al. JBS 2: Joint british
societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart.
;91(Suppl 5):1–52. [PMC free article]
Al Dawish MA, Robert AA, Braham R, Al Hayek AA, Al Saeed A, Ahmed RA, et al.
Diabetes mellitus in Saudi Arabia: A Review of the recent literature. Curr Diabetes Rev.
;12:359–68.
Lindström J, Peltonen M, Eriksson JG, Ilanne-Parikka P, Aunola S, KeinänenKiukaanniemi S, et al. Improved lifestyle and decreased diabetes risk over 13 years:
Long-term follow-up of the randomised finnish diabetes prevention study (DPS)
Diabetologia. 2013;56:284–93.
Centers for Disease Control and Prevention, National diabetes Fact Sheet: National
Estimates and General Information on Diabetes and Prediabetes in the United States.
Department of Health and Human Services, Food and Drug Administration, Center for
Drug Evaluation and Research, Guidance for Industry: Diabetes Mellitus-Evaluating
Cardiovascular Risk in New Antidiabetic Therapies To Treat Type 2 Diabetes. 2008.
[[Last accessed on 2017 Jul 30]]. Available from:
http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/G
uidances/ucm071627.pdf.
European Medicine Agency, Committee for Medicinal Products for Human Use,
Guideline on Clinical Investigation of Medicinal Products in the Treatment of Diabetes
Mellitus. 2010. [[Last accessed on 2017 Jul 30]]. Available from:
http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2010/
/WC500073570.pdf.
Paneni F. 2013 ESC/EASD guidelines on the management of diabetes and
cardiovascular disease: Established knowledge and evidence gaps. Diab Vasc Dis Res.
;11:5–10.
Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al.
Management of hyperglycemia in type 2 diabetes, 2015: A patient-centered approach:
Update to a position statement of the American diabetes association and the European
association for the study of diabetes. Diabetes Care. 2015;38:140–9.
Garrard J. Health Sciences Literature Review Made Easy. United States: Jones and
Bartlett Publishers; 2016.
Siwek J, Gourlay ML, Slawson DC, Shaughnessy AF. How to write an evidence-based
clinical review article. Am Fam Physician. 2002;65:251–8.
Dormandy JA, Charbonnel B, Eckland DJ, Erdmann E, Massi-Benedetti M, Moules IK,
et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in
the PROactive study (PROspective pioglitAzone clinical trial in macroVascular
events): A randomised controlled trial. Lancet. 2005;366:1279–89.
Yoshii H, Onuma T, Yamazaki T, Watada H, Matsuhisa M, Matsumoto M, et al. Effects
of pioglitazone on macrovascular events in patients with type 2 diabetes mellitus at high
risk of stroke: The PROFIT-J study. J Atheroscler Thromb. 2014;21:563–73.
Mahaffey KW, Hafley G, Dickerson S, Burns S, Tourt-Uhlig S, White J, et al. Results
of a reevaluation of cardiovascular outcomes in the RECORD trial. Am Heart J.
;166:240–90.
Punthakee Z, Alméras N, Després JP, Dagenais GR, Anand SS, Hunt DL, et al. Impact
of rosiglitazone on body composition, hepatic fat, fatty acids, adipokines and glucose
in persons with impaired fasting glucose or impaired glucose tolerance: A sub-study of
the DREAM trial. Diabet Med. 2014;31:1086–92.
Bach RG, Brooks MM, Lombardero M, Genuth S, Donner TW, Garber A, et al.
Rosiglitazone and outcomes for patients with diabetes mellitus and coronary artery
disease in the bypass angioplasty revascularization investigation 2 diabetes (BARI 2D)
trial. Circulation. 2013;128:785–94. [PMC free article]
Lago RM, Singh PP, Nesto RW. Congestive heart failure and cardiovascular death in
patients with prediabetes and type 2 diabetes given thiazolidinediones: A meta-analysis
of randomised clinical trials. Lancet. 2007;370:1129–36.
Liu J, Wang LN. Peroxisome proliferator-activated receptor gamma agonists for
preventing recurrent stroke and other vascular events in patients with stroke or transient
ischaemic attack. Cochrane Db Syst Rev. 2014;1
Effect of Intensive Blood-Glucose Control with Metformin on Complications in
Overweight Patients with Type 2 Diabetes (UKPDS 34). UK prospective diabetes study
(UKPDS) group. Lancet. 1998;352:854–65.
Kahn SE, Haffner SM, Heise MA, Herman WH, Holman RR, Jones NP, et al. Glycemic
durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med.
;355:2427–43.
Basit A, Riaz M, Fawwad A. Glimepiride: Evidence-based facts, trends, and
observations (GIFTS). [corrected] Vasc Health Risk Manag. 2012;8:463–72. [PMC
free article]
Klepzig H, Kober G, Matter C, Luus H, Schneider H, Boedeker KH, et al. Sulfonylureas
and ischaemic preconditioning; a double-blind, placebo-controlled evaluation of
glimepiride and glibenclamide. Eur Heart J. 1999;20:439–46.
Pantalone KM, Kattan MW, Yu C, Wells BJ, Arrigain S, Jain A, et al. Increase in
overall mortality risk in patients with type 2 diabetes receiving glipizide, glyburide or
glimepiride monotherapy versus metformin: A retrospective analysis. Diabetes Obes
Metab. 2012;14:803–9.
NAVIGATOR Study Group. Holman RR, Haffner SM, McMurray JJ, Bethel MA,
Holzhauer B, et al. Effect of nateglinide on the incidence of diabetes and cardiovascular
events. N Engl J Med. 2010;362:1463–76.
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