Comparative efficacy and safety of antidiabetic agents for post-transplant diabetes mellitus: a network meta-analysis
Abstract
Background: Post-transplant diabetes mellitus (PTDM) significantly compromises patient and graft outcomes. Although multiple antidiabetic agents are available, their comparative efficacy and safety profiles in this population remain uncertain.
Methods: A systematic literature search was performed across PubMed, Web of Science, Embase, and Cochrane Library to identify clinical trials comparing antidiabetic therapies in PTDM patients. Risk of bias was assessed, and a network meta-analysis was conducted to estimate relative treatment effects. Treatment ranking probabilities, contribution plots, and funnel plots were used to evaluate hierarchy, study influence, and publication bias, respectively.
Results: Twelve studies-including 10 randomized controlled trials (RCTs) and 2 cohort studies-encompassing 7,372 patients were analyzed. The network meta-analysis evaluated four outcomes: HbA1c, fasting plasma glucose (FPG), systolic blood pressure (SBP), and composite major adverse cardiovascular and kidney events (MACE and MAKE). Compared to placebo, insulin produced the greatest reductions in HbA1c (mean difference [MD] - 0.35, 95% CI - 0.90 to 0.20) and FPG (MD - 9.06 mmol/L, 95% CI - 18.66 to 0.53). DPP-4 inhibitors showed the most pronounced decrease in SBP (MD - 3.57 mmHg, 95% CI - 7.29 to 0.16). SGLT2 inhibitors (SGLT2i) demonstrated the strongest tendency to reduce MACE and MAKE events (MD - 1.95, 95% CI - 4.85 to 0.96). SUCRA plots indicated that insulin and SGLT2i ranked…
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: 7,372 participants or records.
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