Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre, Programa de Pós-graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul, RS, Brasil,
Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre, Programa de Pós-graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul, RS, Brasil.
Arch Endocrinol Metab. 2022 Mar 8;66(1):68-76. doi: 10.20945/2359-3997000000440.
The lowest dosage of empagliflozin (10 mg) showed similar benefits on glycated hemoglobin (HbA1c) level, body weight, blood pressure, and total and cardiovascular mortality in comparison with the highest available dose (25 mg) in the EMPAREG trial. These findings have not been clearly demonstrated for canagliflozin and dapagliflozin. The objective was to compare the effect of different doses of SGLT2 inhibitors commercially available in Brazil on HbA1c and body weight of patients with type 2 diabetes. MEDLINE, Cochrane and Embase databases were searched from inception until 11 October 2021 for randomized controlled trials of SGLT2 inhibitors in type 2 diabetes patients, lasting at least 12 weeks. HbA and body weight variations were described using standard mean difference. We performed direct and indirect meta-analysis, as well as a meta-regression with medication doses as covariates. Eighteen studies were included, comprising 16,095 patients. In the direct meta-analysis, SGLT2 inhibitors reduced HbA1c by 0.62% (95% CI -0.66 to -0.59) and body weight by 0.60 kg (95% CI -0.64 to -0.55). In the indirect meta-analysis, canagliflozin 300 mg ranked the highest regarding reductions in HbA and body weight. The remaining medications and dosages were clinically similar, despite some statistically significant differences among them. Canagliflozin 300 mg seems to be more potent in reducing HbA1c and body weight in patients with type 2 diabetes. The remaining SGLT2 inhibitors at different doses lead to similar effects for both outcomes. Whether these glycemic and weight effects are reflected in lower mortality and cardiovascular events is still uncertain and may be a topic for further studies.
在 EMPAREG 试验中，恩格列净的最低剂量（10 毫克）在糖化血红蛋白（HbA1c）水平、体重、血压以及全因和心血管死亡率方面与最高可用剂量（25 毫克）相似。这些发现尚未在卡格列净和达格列净中得到明确证实。本研究旨在比较在巴西上市的不同剂量 SGLT2 抑制剂对 2 型糖尿病患者的 HbA1c 和体重的影响。从建库至 2021 年 10 月 11 日，我们在 MEDLINE、Cochrane 和 Embase 数据库中检索了 SGLT2 抑制剂治疗 2 型糖尿病患者的随机对照试验，试验持续时间至少 12 周。采用标准均数差描述 HbA 和体重的变化。我们进行了直接和间接的荟萃分析，并进行了药物剂量为协变量的荟萃回归分析。纳入了 18 项研究，共纳入 16095 名患者。直接荟萃分析显示，SGLT2 抑制剂可使 HbA1c 降低 0.62%（95%CI -0.66 至 -0.59），体重降低 0.60kg（95%CI -0.64 至 -0.55）。间接荟萃分析显示，卡格列净 300mg 降低 HbA 和体重的作用最强。其余药物和剂量在临床上相似，尽管它们之间存在一些统计学上的显著差异。卡格列净 300mg 似乎在降低 2 型糖尿病患者的 HbA1c 和体重方面更有效。不同剂量的其余 SGLT2 抑制剂在这两个结局方面的作用相似。这些血糖和体重效应是否会降低死亡率和心血管事件，目前仍不确定，可能是进一步研究的主题。
