Cardio and renal benefits with diabetes drugs
A meta-analysis of three large randomised controlled clinical trials has shown significant cardiovascular and renal benefits of sodium-glucose co-transporter-2 inhibitors (SGLT2I) in patients with type 2 diabetes.
The study, published in the Lancet (doi.org/10.1016/S0140-6736(18)32590-X), found that SGLT2I reduced major adverse cardiovascular events (myocardial infarction, stroke, or cardiovascular death), by 11% (HR 0.89, p=0·0014) versus placebo. Benefit was only seen in those with established atherosclerotic disease. SGLT2i also reduced risk of cardiovascular death or hospitalisation for heart failure by 23% (HR 0.77 p<0.0001) and reduced risk of progression of renal disease by 45% (HR 0.55, p<0.0001), versus placebo. Benefit was similar in those with and without atherosclerotic cardiovascular disease.
According to the authors these data suggest that SGLT2I should be considered in patients with type 2 diabetes regardless of the presence of atherosclerotic cardiovascular disease or a history of heart failure, given that SGLT2I safely reduce HbA1c and reduce the risk of hospitalisation for heart failure and progression of renal disease across a broad spectrum of patients with type 2 diabetes. Reductions in major adverse cardiovascular events can also be expected in patients with established atherosclerotic cardiovascular disease, they say.