Evaluation of the efficacy and safety of sodium and glucose type 2 tubular cotransporter inhibitors: systematic review and meta-analysis

Abstract

Type 2 diabetes is a global public health problem associated with increased cardiovascular risk and mortality. This meta-analysis aims to assess the effectiveness of ISGLT2 in managing diabetes, reducing HbA1C levels, and minimizing the relative risk of MACE, while also evaluating safety and both serious and non-serious adverse effects. Compared with conventional therapy, ISGLT2 demonstrated a significant 38% reduction in the risk of cardiovascular death and hospitalization for heart failure, with a marked slowing of the progression of chronic kidney disease. The reduction in the risk of MACE was not statistically significant. The risks of hypoglycaemia, fractures and volume depletion remained unchanged, but there was an increased risk of genitourinary mycotic infections. The analysis revealed that although there was no significant reduction in cardiovascular mortality, there were benefits in terms of reducing hospitalisations for heart failure and slowing renal progression. Challenges in data collection and safety, particularly in relation to hypoglycaemia, fractures, orthostatic hypotension and genitourinary mycotic infections, were identified. Further research is needed to address these issues and assess the safety of ISGLT2 in patients at increased risk of mycotic infections. It is essential to prescribe these drugs with caution, particularly in those with moderate glycaemic control effects.