Age and sex differences in efficacy of treatments for type 2 diabetes: A network meta-analysis
Abstract
Importance Sodium glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor analogues (GLP1ra) and dipeptidyl peptidase-4 inhibitors (DPP4i) improve hyperglycemia, and SGLT2i and GLP1ra reduce the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes. It is not clear whether efficacy varies by age or sex. Objective Assess whether age or sex are associated with differences in efficacy of SGL2i, GLP1ra and DPP4i. Data sources Medline, Embase, trial registries. Study selection Two reviewers screened for randomized controlled trials of SGLT2i, GLP1ra, or DPP4i compared with placebo/active comparator, in adults with type 2 diabetes. Data extraction and synthesis We used individual participant data and aggregate-level data to estimate age-treatment and sex-treatment interactions in Bayesian multi-level network meta-regressions. Main Outcome and Measures HbA1c and MACE Results We identified 601 eligible trials [592 trials with 309,503 participants reporting HbA1c, mean age 59.0, SD (10.7) years, 43.1% female; 23 trials with 168,489 participants reporting MACE, mean age 64.0, SD (8.6) years, 44.0% female] and obtained individual participant data for 103 trials (103 reporting HbA1c and 6 reporting MACE). For SGLT2i, the magnitude of HbA1c reduction versus placebo was attenuated in older compared with younger participants (absolute reduction 0.24%; 95% credible interval (CrI) 0.10-0.38, 0.17%; 95% CrI 0.10-0.24 and 0.25%; 95% CrI…
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: 309,503 participants or records.
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