Skip to Main content Skip to Navigation
Journal articles

Sodium-glucose co-transporter inhibitors in insulin-treated diabetes: a meta-analysis

Abstract : Background Patients with insulin-treated type 2 diabetes (T2D) have a high risk of major adverse cardiovascular events. Sodium-glucose cotransporter inhibitors (SGLTi) improve outcomes without hypoglycaemic risk. Aims To study the effect of SGLTi in patients with T2D with and without background insulin treatment in outcome-driven RCTs. Methods Random effects models. Results A total of 54 374 patients with T2D were included in the analysis, of which 26 551 (48.8%) were treated with insulin. For 3P-MACE in patients without insulin treatment, the HR (95% CI) for the effect of SGLTi vs placebo was 0.93 (0.81–1.05), with moderate heterogeneity (I 2 = 49.2%, Q statistic P = 0.11). In insulin-treated patients, the HR (95% CI) was 0.88 (0.82–0.95), without evidence of heterogeneity (I 2 =0.0%, Q statistic P =0.91). The pooled effect evidenced a 10% reduction of 3P-MACE with SGLTi (HR: 0.90, 95% CI: 0.85–0.96), without SGLTi-by-insulin interaction P = 0.53. For the composite outcome of HF hospitalisation or cardiovascular death in patients without insulin treatment, the HR (95% CI) for the effect of SGLTi vs placebo was 0.77 (0.61-0.92), with marked heterogeneity (I 2 = 66.8%, Q statistic P = 0.02). In insulin-treated patients, the HR (95% CI) was 0.77 (0.68–0.86), without significant heterogeneity (I 2 = 31.7%, Q statistic P = 0.25). The pooled effect evidenced a 23% reduction of HF hospitalisations or cardiovascular death with SGLTi (HR: 0.77, 95% CI: 0.68–0.85), without SGLTi-by-insulin interaction P = 0.98. Conclusion SGLTi reduces cardiovascular events regardless of insulin use. However, the treatment effect is more homogeneous among insulin-treated patients, supporting the use of SGLTi for the treatment of patients with T2D requiring insulin for glycaemic control.
Complete list of metadata

https://hal.univ-lorraine.fr/hal-03364314
Contributor : Erwan BOZEC Connect in order to contact the contributor
Submitted on : Monday, October 4, 2021 - 3:34:29 PM
Last modification on : Friday, April 22, 2022 - 11:42:06 AM
Long-term archiving on: : Wednesday, January 5, 2022 - 6:47:46 PM

Files

SGLT2i_insulin_MA.pdf
Files produced by the author(s)

Identifiers

Collections

Citation

João Pedro Ferreira, Ana Cristina Oliveira, Francisca Saraiva, Francisco Vasques-Nóvoa, Adelino Leite-Moreira. Sodium-glucose co-transporter inhibitors in insulin-treated diabetes: a meta-analysis. European Journal of Endocrinology, BioScientifica, 2021, 184 (6), pp.783-790. ⟨10.1530/EJE-20-1484⟩. ⟨hal-03364314⟩

Share

Metrics

Record views

99

Files downloads

110