Network and Pairwise Meta-Analysis of the Association Between Novel Hypoglycemic Agents and Atrial Fibrillation Risk in Patients With Type 2 Diabetes Mellitus

IF 8.3 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes/Metabolism Research and Reviews Pub Date : 2026-07-15 DOI:10.1002/dmrr.70202

Xuejiao Ye, Qian Wu, Linye Hou, Xinzheng Hou, Yingtian Yang, Chenyan Yang, Mingyu Huang, Shihan Wang

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引用次数: 0

Abstract

Objective

To evaluate the atrial fibrillation (AF) risk of sodium-glucose cotransporter-2 inhibitors (SGLT-2i), glucagonlike peptide-1 receptor agonists (GLP-1RA) and dipeptidyl peptidase-4 inhibitors (DPP-4i) in patients with Type 2 Diabetes Mellitus (T2DM) with network meta-analysis.

Methods

Systematic literature searches were conducted of MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Clinical Trials.gov covering inception till January 31, 2026. Randomized control trials (RCTs) and cohort studies comparing SGLT-2i, GLP-1RA and DPP-4i in diabetes were selected. We performed a network meta-analysis to compare the three drugs indirectly. Results were reported as risk ration (RR) with corresponding 95% confidence interval (CI).

Results

4 RCTs and 21 cohort studies involving 2,171,267 patients were included. Compared with GLP-1RA [RR with 95% CI: 0.86(0.79, 0.95), RR with 95% CI: 0.87(0.78, 0.97)] and DPP-4i[RR with 95% CI: 0.80(0.74, 0.87), RR with 95% CI: 0.81(0.74, 0.88)], SGLT-2i significantly reduced the risk of AF and new-onset AF. While there were no significant difference in the risk of AF recurrence among SGLT-2i, GLP-1RA, and DPP-4i[RR with 95% CI: 0.87(0.68, 1.12), RR with 95% CI: 0.80(0.61, 1.05), RR with 95% CI: 0.92(0.63, 1.33)]. There were also no significant difference in the risk of AF and new-onset AF between GLP-1RA and DPP-4i[RR with 95% CI: 0.93(0.84, 1.03), RR with 95% CI: 0.93(0.83, 1.04)].

Conclusions

The management of T2DM involves the prevention of subsequent cardiovascular complications. The results of this network meta-analysis indicate that SGLT2i is associated with a lower risk of AF in T2DM patients compared to GLP-1RA and DPP-4i. Sensitivity analysis further confirms that SGLT-2i significantly reduces the risk of AF recurrence statistically. These finding suggests that SGLT-2i should be considered as a preferred antidiabetic regimen for patients with T2DM at high risk of AF.

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新型降糖药与2型糖尿病患者房颤风险相关性的网络及两两meta分析

目的：通过网络荟萃分析，评价钠-葡萄糖共转运蛋白-2抑制剂（SGLT-2i）、胰高血糖素样肽-1受体激动剂（GLP-1RA）和二肽基肽酶-4抑制剂（DPP-4i）对2型糖尿病（T2DM）患者心房颤动（AF）的风险。方法：系统检索MEDLINE、Cochrane Central Register of Controlled Trials （Central）、Embase和Clinical Trials.gov的文献，检索时间为2026年1月31日。选择比较SGLT-2i、GLP-1RA和DPP-4i在糖尿病中的作用的随机对照试验（rct）和队列研究。我们进行了网络荟萃分析来间接比较这三种药物。结果以风险比（RR）和相应的95%置信区间（CI）报告。结果：纳入4项随机对照试验和21项队列研究，涉及2171267例患者。与GLP-1RA [RR = 95% CI: 0.86(0.79, 0.95), RR = 95% CI: 0.87(0.78, 0.97)]和DPP-4i[RR = 95% CI: 0.80(0.74, 0.87), RR = 95% CI: 0.81(0.74, 0.88)]相比，SGLT-2i显著降低了AF和新发AF的风险。而SGLT-2i、GLP-1RA和DPP-4i之间的AF复发风险无显著差异[RR = 95% CI: 0.87(0.68, 1.12), RR = 95% CI: 0.80(0.61, 1.05), RR = 95% CI: 0.92(0.63, 1.33)]。GLP-1RA与DPP-4i患者发生房颤和新发房颤的风险也无显著差异[RR (95% CI): 0.93(0.84, 1.03), RR (95% CI): 0.93(0.83, 1.04)]。结论：T2DM的管理包括预防随后的心血管并发症。该网络荟萃分析的结果表明，与GLP-1RA和DPP-4i相比，SGLT2i与T2DM患者AF风险较低相关。敏感性分析进一步证实SGLT-2i在统计学上显著降低房颤复发风险。这些发现表明，SGLT-2i应被视为AF高危T2DM患者的首选降糖方案。

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来源期刊

Diabetes/Metabolism Research and Reviews 医学-内分泌学与代谢

CiteScore

17.20

自引率

2.50%

发文量

审稿时长

4-8 weeks

期刊介绍： Diabetes/Metabolism Research and Reviews is a premier endocrinology and metabolism journal esteemed by clinicians and researchers alike. Encompassing a wide spectrum of topics including diabetes, endocrinology, metabolism, and obesity, the journal eagerly accepts submissions ranging from clinical studies to basic and translational research, as well as reviews exploring historical progress, controversial issues, and prominent opinions in the field. Join us in advancing knowledge and understanding in the realm of diabetes and metabolism.