Diabetes, type 2: Effect on mortality and clinical events of Newer treatments (gliflozins, DPP4 inhibitors)
DISEASE INTERVENTION COMPARISON RESULTS
Diabetes Obes Metab. 2017 Mar;19(3):329-335 Systematic Review
IN diabetes mellitus, type 2 The Use of
oral hypoglycemic agents, sulphonylureas
As Treatment, Chronic
Is worse Than
other oral hypoglycemic agents, metformin, dipeptidyl peptidase 4 (DPP4) inhibitors, sodium-glucose cotransporter-2 inhibitors, or insulin
To modify total and cardiovascular mortality. Total mortality was higher with sulphonylureas compared with metformin (HR 1.37), DPP-4 inh (HR 2.03), thiazolidinediones (HR 1.54) and insulin (HR 1.21). CV mortality was higher than SGLT-2 inh and GLP1 agonists
JAMA. 2018 04 17;319(15):1580-1591 Meta-Analysis
IN diabetes mellitus, type 2 The Use of
renal sodium-glucose cotransporter inhibitor, gliflozins and GLP-1 agonists, but NOT DPP-4 inhibitors
As Treatment, Chronic
Is better Than
placebo, or usual treatment
To reduce all-cause mortality (gliflozins absolute RD -1%, GLP-1 ag -0.6%), cardiovascular mortality and cardiac events. GLP-1 agonists associated with higher risk of withdrawal because of adverse events than gliflozins.
Am J Cardiol. 2012 Sep 15;110(6):826-33 Meta-Analysis
IN diabetes mellitus, type 2, associated cardiovascular events The Use of
incretin enhancer, dipeptidyl peptidase 4 (DPP4) inhibitors
As Treatment, Chronic
Is better Than
other oral diabetic medications or placebo
To reduce at about 4 years nonfatal myocardial infarction or acute coronary syndrome (RR 0.40) or any cardiovascular event (RR 0.48)
N Engl J Med. 2017 Aug 17;377(7):644-657 Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, patients at high cardiovascular risk The Use of
renal sodium-glucose cotransporter inhibitor, gliflozins, canagliflozin, on top or in substitution of previous antidiabetes Tt
As Treatment, Chronic
Is better Than
placebo
To reduce cardiovascular events at 4.5 years: 27% gliflozin VS 31.5% placebo. It also reduced renal adverse outcomes but was associated with more toe / metatarsal amputations (6% gliflozin VS 3% placebo)
N Engl J Med. 2015 Nov 26;373(22):2117-28 Randomized Controlled Trial, Multicenter Study
IN diabetes mellitus, type 2, patients with cardiovascular disease The Use of
renal sodium-glucose cotransporter inhibitor, gliflozins, empagliflozin, on top or in substitution of previous antidiabetes Tt
As Treatment, Chronic
Is better Than
placebo
To reduce death from cardiovascular causes (3.7% empag VS 5.9% placebo), death from any cause (5.7% VS 8.3% placebo) and hospitalization for heart failure (2.7% VS 4.1% placebo)