Patient-centered Management of Type 2 Diabetes Mellitus Based on Specific Clinical Scenarios: Systematic Review, Meta-analysis and Trial Sequential Analysis | Zendy

Lana Catani Ferreira Pinto | Zendy; Dimitris Rucks Varvaki Rados | Zendy; Luciana Reck Remonti | Zendy; Luciana Verçoza Viana | Zendy; Geórgia T. C. Pulz | Zendy; Mariana Palazzo Carpena | Zendy; Roberta P Borges | Zendy; Roberta Marobin | Zendy; Mileni Vanti Beretta | Zendy; Elis Forcellini Pedrollo | Zendy; Thizá Massaia Londero | Zendy; Rafael Vaz Machry | Zendy; Laís Janeczko | Zendy; Milene Moehlecke | Zendy; Mariana Rangel Ribeiro Falcetta | Zendy; Andréa Carla Bauer | Zendy; Sandra Pinho Silveiro | Zendy; Fernando Gerchman | Zendy; Ticiana da Costa Rodrigues | Zendy; Caroline K. Kramer | Zendy; Marcello Casaccia Bertoluci | Zendy; Cristiane Bauermann Leitão | Zendy

Open Access

Patient-centered Management of Type 2 Diabetes Mellitus Based on Specific Clinical Scenarios: Systematic Review, Meta-analysis and Trial Sequential Analysis

Author(s) -

Lana Catani Ferreira Pinto,

Dimitris Rucks Varvaki Rados,

Luciana Reck Remonti,

Luciana Verçoza Viana,

Geórgia T. C. Pulz,

Mariana Palazzo Carpena,

Roberta P Borges,

Roberta Marobin,

Mileni Vanti Beretta,

Elis Forcellini Pedrollo,

Thizá Massaia Londero,

Rafael Vaz Machry,

Laís Janeczko,

Milene Moehlecke,

Mariana Rangel Ribeiro Falcetta,

Andréa Carla Bauer,

Sandra Pinho Silveiro,

Fernando Gerchman,

Ticiana da Costa Rodrigues,

Caroline K. Kramer,

Marcello Casaccia Bertoluci,

Cristiane Bauermann Leitão

Publication year - 2020

Publication title -

the journal of clinical endocrinology and metabolism

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 2.206

H-Index - 353

eISSN - 1945-7197

pISSN - 0021-972X

DOI - 10.1210/clinem/dgaa534

Subject(s) - mace , medicine , randomized controlled trial , clinical endpoint , type 2 diabetes , meta analysis , type 2 diabetes mellitus , diabetes mellitus , heart failure , adverse effect , kidney disease , relative risk , intensive care medicine , confidence interval , endocrinology , percutaneous coronary intervention , myocardial infarction

New antihyperglycemic medications have been proven to have cardiovascular (CV) and renal benefits in type 2 diabetes mellitus (T2DM); however, an evidence-based decision tree in specific clinical scenarios is lacking. Materials and Methods Systematic review and meta-analysis of randomized controlled trials (RCTs), with trial sequential analysis (TSA). Randomized controlled trial inclusion criteria were patients with T2DM from 1 of these subgroups: elderly, obese, previous atherosclerotic CV disease (ASCVD), previous coronary heart disease (CHD), previous heart failure (HF), or previous chronic kidney disease (CKD). Randomized controlled trials describing those subgroups with at least 48 weeks of follow-up were included. Outcomes: 3-point major adverse cardiovascular events (MACE), CV death, hospitalization due to HF, and renal outcomes. We performed direct meta-analysis with the number of events in the intervention and control groups in each subset, and the relative risk of the events was calculated. Results Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) were the only antihyperglycemic agents related to a reduction in CV events in different populations. For obese and elderly populations, GLP-1 RA were associated with benefits in 3-point MACE; for patients with ASCVD, both SGLT2i and GLP-1 RA had benefits in 3-point MACE, while for patients with CHD, only SGLT2i were beneficial. Conclusions SGLT2i and GLP-1 RA reduced CV events in selected populations: SGLT2i led to a reduction in events in patients with previous CHD, ASCVD, and HF. GLP-1 RA led to a reduction in CV events in patients with ASCVD, elderly patients, and patients with obesity. Trial sequential analysis shows that these findings are conclusive. This review opens a pathway towards evidence-based, personalized treatment of T2DM. Registration PROSPERO CRD42019132807

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