Network and Pairwise Meta-Analysis of the Association Between Novel Hypoglycemic Agents and Atrial Fibrillation Risk in Patients With Type 2 Diabetes Mellitus
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…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 2,171,267 participants or records.
Read the paper
Related studies
- Strategy for Mitigating DKA Risk in Patients with Type 1 Diabetes on Adjunctive Treatment with SGLT Inhibitors: A STICH Protocol
- Glucoraphanin: a broccoli sprout extract that ameliorates obesity-induced inflammation and insulin resistance
- SGLT2 Inhibitors in Heart Failure: Targeted Metabolomics and Energetic Metabolism
- Mechanisms of blood pressure reduction with sodium-glucose co-transporter 2 (SGLT2) inhibitors
- Sodium-glucose cotransporter inhibitors: beyond glycaemic control
- Decoding the effects of SGLT2 inhibitors on cardiac arrhythmias in heart failure
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.