Efficacy and safety of SGLT2 inhibitor empagliflozin in T2DM with established cardiovascular disease: a systematic review and meta-analysis of RCTs

SGLT2抑制剂恩格列净治疗合并心血管疾病的2型糖尿病患者的疗效和安全性:一项随机对照试验的系统评价和荟萃分析

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Abstract

INTRODUCTION: Effective treatment approaches are required for type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVDs) because these two diseases pose a big health issue for humans. Various medications, but with limitations in their efficacy, are available for the treatment of the above-mentioned diseases, but a drug, empagliflozin, a sodium-glucose cotransporter-2 inhibitor, has shown promising benefits for patients with T2DM and CVD, highlighting the need for a thorough review of its efficacy and safety. METHODS: We searched online databases till 30 June 2024, and a total of 15 trials involving 8296 participants were included in this study. Evaluating the changes in HbA1c was a main concern of our study, while weight-related metrics [such as body weight and Body Mass Index (BMI)], cardiovascular indicators [like systolic blood pressure (SBP), diastolic blood pressure (DBP), changes in left ventricular ejection fraction %, and heart rate], and various laboratory values [including fasting plasma glucose (FPG), C-reactive protein (CRP), hematocrit, estimated glomerular filtration rate] were considered as secondary assessments. RESULTS: Our study concluded that empagliflozin significantly reduced HbA1c levels [standardized mean difference (SMD) = -0.62, 95% CI = -0.95 to -0.30, I (2) = 85%, P = 0.0001], indicating improved glycemic control. Additionally, a reduction in body weight was also noted (SMD = -2.32, 95% CI = -3.42 to -1.21, I (2) = 54%, P < 0.0001). The drug also demonstrated favorable outcomes for secondary endpoints. Meta-regression and subgroup analyses provided insights into the variability of treatment effects across different populations. CONCLUSIONS: The efficacy of empagliflozin in managing T2DM and CVD is evaluated by this pooled analysis, highlighting great improvement in glycemic control and weight reduction. Further research is needed for empagliflozin's long-term safety and efficacy across populations.

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