Do SGLT2 Inhibitors Improve Cardio-Renal Outcomes in Patients With Type II Diabetes Mellitus: A Systematic Review

Abstract

Diabetes mellitus (DM) is associated with dreadful changes in the cardiovascular and renal systems, causing increased morbidity and mortality. Sodium-glucose cotransport-2 (SGLT2) inhibitors belong to the oral hypoglycemic group of drugs believed to reduce these events by various mechanisms in DM. We performed a systematic review to determine the effectiveness of SGLT2 inhibitors in reducing cardiovascular and renal complications and address safety concerns in participants with type 2 diabetes mellitus (T2DM).We explored PubMed, PubMed Central, Medical Literature Analysis and Retrieval System Online (MEDLINE), Cochrane library, and ResearchGate for randomized controlled trials and observational studies done on the advantages of SGLT2 inhibitors in the prevention or reduction of worsening cardiovascular and renal changes in T2DM. Studies were screened for the quality assessment using the Cochrane risk-of-bias assessment tool and Newcastle-Ottawa scale. We screened 5615 articles, out of which 22 articles with 7,02,977 diabetes mellitus patients treated with SGLT2 inhibitors were used for the systematic review after meticulously filtering articles based on inclusion and exclusion criteria. The trials included one of the following drugs -empagliflozin, dapagliflozin, canagliflozin, and luseogliflozin. SGLT2 inhibitors significantly reduced the risk of heart failure (HF), frequency of hospitalizations due to HF, all-cause mortality, cardiovascular mortality, and nonfatal myocardial infarction. Renal outcomes showed a significant lowering of risk of acute kidney failure, progression of chronic kidney disease, renal mortality, and improvement in urinary albumin creatinine ratio. We noticed an initial worsening of the estimated glomerular filtration rate followed by stabilizing and reaching the baseline on long-term treatment, especially in end-stage renal failure patients.The review showed that SGLT2 inhibitors have adverse reactions similar to that of a placebo, with a slight increase in treatable genital mycotic and urinary tract infections but no evidence of diabetic ketoacidosis, fractures, and amputations. According to the available data, SGLT2 inhibitors can significantly prevent or reduce cardiovascular diseases and kidney abnormalities in patients with type 2 diabetes mellitus with tolerable safety outcomes.

[Retracted] Effect of Dapagliflozin on Clinical Outcome after Drug‐Eluting Stent Implantation in Elderly T2DM Patients: A Real‐World Study

“…Currently, STLT2 inhibitors listed in China include dapagliflozin, canagliflozin, and empagliflozin, among which dapagliflozin is the most widely used [16,17]. SGLT2 inhibitors, as a new type of hypoglycemic agent, not only have a good effect on blood glucose control but also have significant benefits on cardiovascular disease, cerebrovascular disease, body weight, blood pressure, blood lipid, kidney function, and other indicators [18,19]. This study compared the effect of dapagliflozin treatment on the laboratory indicators of Note: a represents P < 0:05 when compared between before and after treatment within the group, b represents P < 0:05 when compared between the two groups after treatment, and c represents P < 0:05 when compared the differences before/after treatment between the two groups.…”

Effects of Dapagliflozin in Combination with Metoprolol Sustained-Release Tablets on Prognosis and Cardiac Function in Patients with Acute Myocardial Infarction after PCI

“…At present, the mechanism of dapagliflozin in the treatment of cardiovascular diseases has not been fully clarified, which may include a variety of mechanisms. The initial study believed that dapagliflozin could reduce the toxicity of glucose to the heart through the hypoglycemic effect, so dapagliflozin is used more in patients with cardiovascular disease complicated by diabetes [13][14][15]. Studies suggest that dapagliflozin may increase the synthesis of the hepatic ketone body, enhance myocardial energy metabolism, and improve cardiac function.…”

A Systematic Review of Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors and Sympathetic Nervous System Inhibition: An Underrated Mechanism of Cardiorenal Protection

“…Significant microvascular alterations cause chronic kidney disease (CKD), and it affects 43.2% of type 2 diabetic mellitus (T2DM) patients. Cardiovascular disease (CVD) is a severe complication that affects 32.2% of DM type II patients and causes mortality in 50.3% of those who die from it [ 1 ]. Data from large-scale randomized controlled trials (RCTs) using SGLT2 inhibitors have shown considerable cardiovascular and renal improvement across various subgroups in heart failure (HF) patients.…”