Analysis of 2,349,683 patients indicates that SGLT2 inhibitors, GLP-1 receptor agonists, and DPP4 inhibitors significantly reduce the incidence of new-onset /flutter compared to insulin.
SGLT2 inhibitors showed a relative risk of 0.23 for new-onset AF/AFL when compared to insulin.
GLP-1 receptor agonists resulted in a relative risk of 0.28 for new-onset AF/AFL compared to insulin.
DPP4 inhibitors demonstrated a relative risk of 0.34 for new-onset AF/AFL in comparison to insulin.
SGLT2 inhibitors were more effective than metformin, sulfonylureas, non-sulfonylureas, and thiazolidinediones in reducing new-onset AF/AFL.
GLP-1 receptor agonists were more effective than metformin, sulfonylureas, and thiazolidinediones in reducing new-onset AF/AFL.
Metformin, sulfonylureas, and thiazolidinediones were less effective than DPP4 inhibitors in preventing new-onset AF/AFL.
Simplified
OBJECTIVE: Diabetes is considered a significant risk factor for the development of /flutter (AF/AFL). However, there is still insufficient evidence to determine the varying effects of different (HDs) on the incidence of new-onset AF/AFL in diabetic patients. To address this gap, we conducted a network meta-analysis to investigate whether various HDs have different effects on the risk of new-onset AF/AFL compared with insulin.
METHOD: We conducted a comprehensive search in PubMed, EMBASE, Cochrane Library, and Web of Science to identify all clinical trials investigating the association between various HDs or insulin and incident AF/AFL up until April 1, 2024. Bayesian random-effects model was used for network meta-analysis, and the results were expressed as relative risk (RR) and 95% confidence interval (CI).
RESULT: After searching 2070 articles, a total of 12 studies (2,349,683 patients) were included in the network meta-analysis. The treatment regimen comprised insulin and 8 HDs hypoglycemic drugs, which are sodium-dependent glucose transporters 2 inhibitor (SGLT2i), glucagon-like peptide 1 receptor agonist (GLP-1RA), dipeptidyl peptidase 4 inhibitors (DPP4i), metformin (Met), sulfonylureas (SU), non-sulfonylureas (nSU), thiazolidinedione (TZD) and α-glycosidase inhibitors (AGI). The use of SGLT2i [RR 0.23, 95%CI (0.11, 0.49)], GLP-1RA [RR 0.28, 95%CI (0.13, 0.57)], and DPP4i [RR 0.34, 95%CI (0.17, 0.67)] demonstrated significant efficacy in reducing the incidence of new-onset AF/AFL when compared to insulin. When HDs were compared in pairs, SGLT2i is more effective than Met [RR 0.35, 95% CI (0.19, 0.62)], SU (RR 0.27, 95% CI (0.14, 0.51)], nSU [RR 0.28, 95% CI (0.08, 0.95)], TZD [RR 0.34, 95% CI (0.17, 0.7)], GLP-1RA is more effective Met [RR 0.42, 95% CI (0.25, 0.71)], SU (RR 0.33, 95% CI (0.18, 0.6)], TZD [RR 0.41, 95% CI (0.21, 0.82)], while Met[RR 1.98, 95% CI (1.23, 3.23)], SU [RR 2.54, 95% CI (1.46, 4.43)], TZD [RR 2.01, 95% CI (1.05, 3.79)] was not as effective as DPP4i.
CONCLUSION: SGLT-2i, GLP-1RA, and DPP4i showed a superior efficacy in reducing the risk of new-onset AF/AFL compared to insulin therapy.
Key numbers
0.23
Reduction in risk with SGLT2i
Relative risk (RR) of new-onset with SGLT2i vs. insulin
0.28
Reduction in risk with GLP-1RA
Relative risk (RR) of new-onset with GLP-1RA vs. insulin
0.34
Reduction in risk with DPP4i
Relative risk (RR) of new-onset with DPP4i vs. insulin
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