Efficacy and safety of 11 sodium-glucose cotransporter-2 inhibitors at different dosages in type 2 diabetes mellitus patients inadequately controlled with metformin: a Bayesian network meta-analysis

Feb 26, 2025BMJ open

Effectiveness and safety of 11 doses of SGLT2 inhibitors in type 2 diabetes patients not well controlled with metformin

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Abstract

23 randomized controlled trials involving 9144 patients assessed efficacy and safety of sodium-glucose cotransporter-2 inhibitors (SGLT2is) as add-on therapy to metformin in type 2 diabetes mellitus.

  • Most SGLT2is reduced glycated hemoglobin () by 0.45% to 0.80%, fasting plasma glucose (FPG) by 0.78 to 2.02 mmol/L, and body weight by 0.88 to 2.67 kg compared to placebo.
  • 10 mg of henagliflozin increased the incidence of adverse events, while none of the interventions increased risks of serious adverse events or urinary tract infections.
  • 50 mg of empagliflozin was associated with higher risks of hypoglycemia, and 10 mg of empagliflozin increased the risk of genital infections.
  • 15 mg of ertugliflozin showed optimal efficacy for HbA1c reduction, while 300 mg of canagliflozin was the best option for FPG reduction and weight loss.
  • Results suggest some novel SGLT2is may have promising efficacy and safety profiles, but further research is needed to confirm these findings.

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Key numbers

-0.80%
Reduction
Reduction observed with 10 mg of henagliflozin.
-2.02 mmol/L
FPG Reduction
Highest reduction among interventions compared to placebo.
-2.67 kg
Weight Loss
Notable reduction associated with 300 mg of canagliflozin.

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