POEMs
Patient-Oriented Evidence That Matters
SGLT2 Inhibitors or GLP-1 Receptor Agonists Reduce Cardiovascular Outcomes in Patients with Type 2 Diabetes
Am Fam Physician. 2021 Aug ;104(2):206.
Clinical Question
Do sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide-1 (GLP-1) receptor agonists reduce patient-oriented outcomes in patients with type 2 diabetes mellitus?
Bottom Line
SGLT2 inhibitors, the diabetes medications ending in -flozin (such as dapagliflozin [Farxiga]), and GLP-1 receptor agonists, the -tide medications (such as dulaglutide [Trulicity]), decrease cardiovascular and renal outcomes to a greater extent than placebo or other treatments. They should be considered in addition to metformin and other glucose-lowering treatments for most patients with type 2 diabetes. (Level of Evidence = 1a)
Synopsis
The researchers searched three databases, including Cochrane CENTRAL, to identify randomized trials that compared SGLT2 inhibitors or GLP-1 receptor agonists with other treatment approaches. Two researchers independently screened studies for inclusion, extracted the data, and assessed the studies for risk of bias. Because there are a handful of drugs in each class that have not been directly compared with one another, the researchers completed a network meta-analysis, which combines direct and indirect evidence across studies to allow cross-comparison. They identified 764 trials including 421,346 patients, which allowed a view of the results according to patient baseline cardiovascular risk. The quality of the studies was generally high, with no heterogeneity for most outcomes. Both drug classes lowered all-cause mortality, cardiovascular mortality, nonfatal myocardial infarction, and kidney failure. SGLT2 inhibitors were more effective at reducing hospital admission, and GLP-1 receptor agonists were more likely to reduce nonfatal stroke. The absolute benefit of treatment varied based on underlying cardiac risk; for example, two to five fewer deaths per 1,000 patients over five years in patients at low risk and 24 to 48 fewer deaths per 1,000 patients at high risk. A calculator is available (https://magicevidence.org/match-it/200
POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.
For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.
To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.
This series is coordinated by Sumi Sexton, MD, editor-in-chief.
A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.
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