Evaluation of the hypoglycemic and hypotensive efficacy of sodium-glucose cotransporter-2 inhibitors in patients with type 2 diabetes: A model-based dose–response network meta-analysis

Abstract

Aims

To study the dose effect relationship of sodium-glucose cotransporter-2 inhibitor (SGLT-2i) in reducing blood glucose and blood pressure in type 2 diabetes mellitus (T2DM).

Materials and methods

We searched PubMed, Embase, Web of Science, Cochrane Library, and clinicaltrials.gov for related literature, with the search period spanning from the establishment of each platform to May 1, 2024. The main analysis method used is model-based network meta-analysis.

Results

A total of 192 RCTs involving 67,677 patients with T2DM were included in this study. The results showed that SGLT-2i reduced glycated hemoglobin A1c (HbA1c) in T2DM by 0.50 ​% (95 ​% CI: 0.49 ​% ∼ 0.50 ​%) compared with placebo. The hypoglycemic effects of Luseogliflozin and Henagliflozin on HbA1c ranked first and second, with values of 0.92 ​% (95 ​% CI: 0.61 ​% ∼ 1.28 ​%) and 0.91 ​% (95 ​% CI: 0.61 ​% ∼ 1.36 ​%), respectively. Compared with placebo, the results showed that SGLT-2i lowered systolic blood pressure (SBP) by 3.23 ​mmHg (95 ​% CI: 3.19 ​mmHg ∼ 3.26 ​mmHg) and diastolic blood pressure (DBP) by 4.16 ​mmHg (95 ​% CI: 4.13 ​mmHg ∼ 4.18 ​mmHg) in patients with T2DM, respectively. Canagliflozin showed the greatest reduction in SBP and Luseogliflozin showed the greatest reduction in DBP, respectively.

Conclusions

The effect of SGLT-2i in reducing HbA1c in patients with T2DM increased with increasing daily dose, with Luseogliflozin and Henagliflozin being the most effective. SGLT-2i significantly reduced both SBP and DBP in T2DM, but there was no significant dose–response relationship. Among the SGLT-2i, Canagliflozin and Luseogliflozin exhibited better antihypertensive effects.