Cardiovascular efficacy and safety of antidiabetic agents: A network meta-analysis of randomized controlled trials

Review (43 RCTs; n= 255,693) found GLP-1 receptor agonists, SGLT-2 inhibitors and thiazolidinediones were associated with a reduced risk of 3-point MACE (non-fatal MI, non-fatal stroke or CV death), with relative reductions of 13%, 11% and 15%, respectively vs placebo.

SPS commentary:

Other key findings of this analysis included:

  • GLP-1 receptor agonists, SGLT-2 inhibitors and thiazolidinediones were associated with lower risks of three-point MACE than insulin (RR 0.84, 0.87 and 0.82, respectively) or sulphonylureas (0.85, 0.87, 0.83) or DPP-4 inhibitors (0.87, 0.89, 0.85).
  • SGLT-2 inhibitors reduced the risk of a composite renal outcome by >30% compared with insulin (RR 0.68; 0.51-0.91), DPP-4 inhibitors (0.63; 0.49-0.80) and placebo (0.66; 0.6-0.74)

The authors point out the limitations of their research, including for example the lack of uniform definitions for the renal outcomes studied, and heterogeneity within the trial populations in terms of baseline cardiovascular and renal risks.

Diabetes, Obesity and Metabolism