Patient-centered Management of Type 2 Diabetes Mellitus Based on Specific Clinical Scenarios: Systematic Review, Meta-analysis and Trial Sequential Analysis
| Autor: | Thizá Massaia Londero, Mileni Vanti Beretta, Cristiane Bauermann Leitão, Rafael Vaz Machry, Sandra Pinho Silveiro, Fernando Gerchman, Roberta Marobin, Ticiana da Costa Rodrigues, Lana Catani Ferreira Pinto, Andrea Carla Bauer, Dimitris Rucks Varvaki Rados, Caroline K. Kramer, Luciana Verçoza Viana, Roberta de Pádua Borges, Milene Moehlecke, Mariana Palazzo Carpena, Lais Janeczko, Elis Forcellini Pedrollo, Marcello Casaccia Bertoluci, Luciana Loss Reck Remonti, Georgia Tupi Caldas Pulz, Mariana Rangel Ribeiro Falcetta |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Endocrinology Diabetes and Metabolism Clinical Biochemistry Disease 030204 cardiovascular system & hematology Biochemistry Incretins Glucagon-Like Peptide-1 Receptor law.invention 03 medical and health sciences 0302 clinical medicine Endocrinology Randomized controlled trial law Internal medicine Diabetes mellitus Patient-Centered Care medicine Humans Hypoglycemic Agents 030212 general & internal medicine Sodium-Glucose Transporter 2 Inhibitors Randomized Controlled Trials as Topic Dipeptidyl-Peptidase IV Inhibitors business.industry Biochemistry (medical) Type 2 Diabetes Mellitus Disease Management medicine.disease Diabetes Mellitus Type 2 Meta-analysis Relative risk business Mace Kidney disease |
| Zdroj: | The Journal of clinical endocrinology and metabolism. 105(11) |
| ISSN: | 1945-7197 |
| Popis: | Introduction 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 |
| Databáze: | OpenAIRE |
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