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Which Antidiabetic Drugs Are Associated With Improved Left Ventricular Function?


February 04, 2020

Data published in Cardiovascular Diabetology indicate that sodium glucose cotransporter 2 (SGLT-2) inhibitors “are superior to other [antidiabetic] drugs in pairwise comparisons” in improving left ventricular (LV) function among patients with type 2 diabetes and cardiovascular disease (CVD).

In their systematic review and meta-analysis, researchers compared the effects of various antidiabetic drugs, including SGLT-2 inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) agonists, metformin, sulfonylureas, and thiazolidinediones on left ventricular remodeling among patients with diabetes and CVD.

They analyzed randomized controlled trials and a small number of cohort studies that had recorded differences in the mean changes in LV echocardiographic parameters between treatment groups and control groups.

Ultimately, the researchers found that GLP-1 agonists were more significantly associated with improved LV ejection fraction, LV end-systolic volume and E/e′ compared with placebo. SGLT-2 inhibitors were more significantly associated with improved LV end-diastolic diameter and E/e′ compared with placebo, whereas DPP-4 inhibitors were more strongly associated with a negative impact on LV end-diastolic volume compared with placebo.

Specifically, the results of the analysis indicated that the difference in the mean change in LV ejection fraction between GLP-1 agonists and placebo in treatment effect was greater than 0, with a mean difference (MD) of 2.04%.

In addition, the researchers observed similar results for the difference in mean change in:

  • LV end-diastolic diameter between SGLT-2 inhibitors and placebo, with an MD of −3.3 mm.
  • LV end-systolic volume between GLP-1 agonists and placebo, with an MD of −4.39 ml.
  • E/e′ between GLP-1 agonists and placebo, with an MD of −1.05.
  • E/e′ between SGLT-2 inhibitors and placebo, with an MD of −1.91.

“GLP-1 agonist and SGLT-2 inhibitor treatment may serve as novel therapeutics for treating hyperglycemia and reducing cardiovascular comorbidities,” the researchers wrote.

—Christina Vogt

Reference:
Zhang DP, Xu L, Wang LF, Wang HJ, Jiang F. Effects of antidiabetic drugs on left ventricular function/dysfunction: a systematic review and network meta-analysis. Cardiovasc Diabetol. 2020;19(10). https://doi.org/10.1186/s12933-020-0987-x.

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