Comparative effectiveness and safety of Sodium-glucose Cotransporter-2 (SGLT2) inhibitors in type 2 diabetes mellitus: rapid review of systematic reviews and meta-analyzes

Abstract

Aim: To evaluate the evidence of effectiveness and safety of sodium glucose co-transporter inhibitors type 2 (iSGLT2) in patients with type 2 diabetes mellitus.

Methodology: A rapid systematic review of systematic reviews of iSGLT2 was performed in the Medline and Embase databases until September 2019. Cardiovascular outcome was major cardiovascular adverse events (MACE): death due to cardiovascular causes, non-fatal stroke and acute non-fatal myocardial infarction, in addition to hospitalization for heart failure; renal outcome was progression of renal disease, decrease in glomerular filtration rate and albumin-creatinine ratio. The safety outcome comprehended hypoglycemia, fractures, and urinary infections. The methodological quality was evaluated with the modified A measurement Tool to Assess Systematic Review (AMSTAR-2) tool.

Results: Five systematic reviews of the literature of medium and high-quality AMSTAR-2 were included. The iSGLT2 reduces the risk of cardiovascular mortality by 23%, from all-cause mortality by 20% and in hospital admission for heart failure in 33% versus standard care. In addition, the iSGLT2 slows the deterioration of renal disease and reduces the progression to albumin in patients with documented proteinuria. In the safety outcome, there is a greater possibility of developing genitourinary tract infections with respect to oral antidiabetics.

Conclusions: The evidence suggests that iSGLT2 are effective in reducing the risk of cardiovascular mortality, all-cause mortality, hospital admission for heart failure, progression of nephropathy and the development of end-stage renal disease. In safety outcomes, the evidence suggests that iSGLT2 have a lower risk of hypoglycemic events.