Evaluation of three mechanisms of action (SGLT2 inhibitors, GLP-1 receptor agonists, and sulfonylureas) in treating type 2 diabetes with heart failure: a systematic review and network meta-analysis of RCTs
Abstract
OBJECTIVE: We aimed to evaluate and compare the efficacy and safety of three antidiabetic drug classes-SGLT2 inhibitors, GLP-1 receptor agonists, and sulfonylureas-in patients with type 2 diabetes mellitus (T2DM) complicated by heart failure (HF). We focused on their differential effects on both cardiovascular outcomes (e.g., heart failure biomarkers and cardiac function) and metabolic outcomes (e.g., glycemic control and body weight), aiming to determine whether the newer agents offer superior cardiometabolic benefits. A network meta-analysis was conducted to integrate available evidence and compare all interventions simultaneously.
METHODS: A comprehensive literature search was performed in PubMed, EMBASE, and the Cochrane Library. encompassing all available records up to December 10, 2024. Fourteen RCTs were included. A Bayesian network meta-analysis was utilized to integrate direct and indirect evidence, facilitating a comparative ranking of various SGLT2 inhibitors-canagliflozin (CANA), ipragliflozin (IPRA), empagliflozin (EMPA), remogliflozin (REMO), licogliflozin (LICO), and dapagliflozin (DAPA)-as well as one GLP-1 receptor agonist-semaglutide (SEMA)-and a sulfonylurea-glimepiride (GLIM)-with respect to their efficacy and safety profiles.
RESULTS: SEMA (SMD = -0.22, 95% CI: -1.31 to 0.87) demonstrated the most favorable outcome in reducing BNP levels. LICO (SMD = -0.91, 95% CI: -1.76 to -0.06) ranked highest for body weight reduction, indicating the greatest impact.…
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