Kalluri Sahithi Reddy, Bhutta Tinaz H, Hannoodee Hanan, Al Khalili Mahmoud, Theik Nyein Wint Yee, Raji Oluwatimilehin E, Shenwai Priya, Shah Rutul, Khan Safeera
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Farfield, USA.
Cureus. 2021 Sep 2;13(9):e17668. doi: 10.7759/cureus.17668. eCollection 2021 Sep.
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.
糖尿病（DM）与心血管和肾脏系统的严重变化相关，会导致发病率和死亡率增加。钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂属于口服降糖药物，据信可通过多种机制减少糖尿病患者的这些不良事件。我们进行了一项系统评价，以确定SGLT2抑制剂在降低心血管和肾脏并发症方面的有效性，并解决2型糖尿病（T2DM）患者的安全性问题。我们在PubMed、PubMed Central、医学文献分析和联机检索系统（MEDLINE）、Cochrane图书馆以及ResearchGate中检索了关于SGLT2抑制剂在预防或减少T2DM患者心血管和肾脏病变恶化方面优势的随机对照试验和观察性研究。使用Cochrane偏倚风险评估工具和纽卡斯尔-渥太华量表对研究进行质量评估筛选。我们筛选了5615篇文章，其中22篇文章共纳入702977例接受SGLT2抑制剂治疗的糖尿病患者，在根据纳入和排除标准精心筛选文章后用于系统评价。这些试验包括以下药物之一——恩格列净、达格列净、卡格列净和鲁格列净。SGLT2抑制剂显著降低了心力衰竭（HF）风险、因HF住院的频率、全因死亡率、心血管死亡率和非致命性心肌梗死。肾脏结局显示急性肾衰竭风险、慢性肾脏病进展、肾脏死亡率显著降低，尿白蛋白肌酐比值改善。我们注意到估计肾小球滤过率最初会恶化，随后在长期治疗中趋于稳定并恢复到基线水平，尤其是在终末期肾衰竭患者中。该评价表明，SGLT2抑制剂的不良反应与安慰剂相似，可治疗的生殖器霉菌感染和尿路感染略有增加，但没有糖尿病酮症酸中毒、骨折和截肢的证据。根据现有数据，SGLT2抑制剂可显著预防或减少2型糖尿病患者的心血管疾病和肾脏异常，且安全性结果可耐受。
