Efficacy and tolerability of sodium‐glucose co‐transporter‐2 inhibitors and glucagon‐like peptide‐1 receptor agonists: A systematic review and network meta‐analysis

Feb 21, 2020Diabetes, obesity & metabolism

Effectiveness and side effects of two diabetes drug types: SGLT-2 inhibitors and GLP-1 receptor agonists

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Abstract

A total of 31,384 participants from 64 trials were analyzed for changes in glycated haemoglobin (HbA1c) levels.

Long-acting GLP-1 receptor agonists (GLP-1RAs) significantly reduced HbA1c compared to short-acting GLP-1RAs and sodium-glucose co-transporter 2 inhibitors (SGLT-2is).
Semaglutide, a long-acting GLP-1RA, demonstrated a greater reduction in HbA1c levels compared to placebo at both 24 weeks (-1.49%) and 52 weeks (-1.38%).
Long-acting GLP-1RAs were associated with reductions in body weight and waist circumference.
SGLT-2is were linked to a reduction in blood pressure.
SGLT-2is showed a higher risk of genital infections compared to long-acting GLP-1RAs, while long-acting GLP-1RAs were associated with increased risk of diarrhea compared to SGLT-2is.
No other significant differences in adverse events between SGLT-2is and GLP-1RAs were identified.

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AIM: To compare the efficacy and tolerability of sodium-glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in adults with type 2 diabetes.

MATERIALS AND METHODS: Electronic databases were searched from inception to 24 April 2019 for randomized controlled trials reporting change in glycated haemoglobin (HbA1c) at approximately 24 and/or 52 weeks for SGLT-2is and/or GLP-1RAs (classified as short- and long-acting). Bayesian network meta-analyses were conducted to compare within and between SGLT-2i and GLP-1RA classes for cardiometabolic efficacy and adverse events (PROSPERO registration number: CRD42018091306).

RESULTS: Sixty-four trials (53 trials of 24 weeks; seven trials of 52 weeks; four trials of both 24 and 52 weeks), comprising 31 384 participants were identified. Compared with placebo, all treatments improved HbA1c. Long-acting GLP-1RAs reduced HbA1c compared with short-acting GLP-1RAs and SGLT-2is, with semaglutide showing greater reduction compared with placebo [24 weeks: -1.49% (95% credible interval: -1.76, -1.22); 52 weeks: -1.38% (-2.05, -0.71)] and all other treatments. Long-acting GLP-1RAs showed benefits in body weight and waist circumference reduction, while SGLT-2is reduced blood pressure. SGLT-2is showed increased risk of genital infection in comparison with long-acting GLP-1RAs [odds ratio (95% credible interval): 5.26 (1.45, 25.00)], while GLP-1RAs showed increased risk of diarrhoea in comparison with SGLT-2is [short-acting GLP-1RAs: 1.65 (1.09, 2.49); long-acting GLP-1RAs: 2.23 (1.51, 3.28)]. No other differences were found between SGLT-2is and GLP-1RAs in adverse events.

CONCLUSION: Long-acting GLP-1RAs showed superiority in reducing HbA1c levels, body weight and waist circumference. SGLT-2is showed reductions in blood pressure levels. This review provides essential evidence to guide treatment recommendations in the management of type 2 diabetes.

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Efficacy and tolerability of sodium‐glucose co‐transporter‐2 inhibitors and glucagon‐like peptide‐1 receptor agonists: A systematic review and network meta‐analysis

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