Abstract 9568: Sodium-Glucose Cotransporter 2 Inhibitors Prevent New-Onset Type 2 Diabetes in Adults With Prediabetes: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Introduction: Although the preventive effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors for new-onset diabetes was investigated as secondary analyses of recent randomized controlled trials (RCTs), the synthesized evidence is lacking. We thus aimed to summarize the effects of SGLT2 inhibitors on preventing new-onset diabetes. Hypothesis: We assessed the hypothesis that SGLT2 inhibitors reduce the incidence of diabetes among patients with prediabetes and heart failure or chronic kidney disease. Methods: In this systematic review and meta-analysis of RCTs, MEDLINE and EMBASE were searched through February 11, 2022. Two independent authors screened the search results and extracted data from eligible RCTs (including both original and post hoc analyses) comparing SGLT2 inhibitors and placebo for the risk of new-onset diabetes among adults with prediabetes. No restrictions on publication date and language were applied. Meta-analysis was conducted using random-effects models to calculate risk ratios and 95% confidence intervals (CIs). Results: We included 4 RCTs with 5655 participants who had prediabetes. All studies had a low risk of bias and were conducted for treatments of heart failure or chronic kidney disease. Based on the random-effects meta-analysis, SGLT2 inhibitors were significantly associated with a lower risk of new-onset diabetes (relative risk, 0.79; 95% CI, 0.68 to 0.93, I2 =0·0%). The relative risks of new-onset diabetes in dapagliflozin and empagliflozin were 0.68 (95% CI, 0.52 to 0.89) and 0.87 (95% CI, 0.72 to 1.04), respectively (p-for-heterogeneity =0.14). The frequency of severe hypoglycemia was not elevated in the SGLT2 inhibitors group compared to the placebo group. Conclusions: In this meta-analysis, SGLT2 inhibitors were associated with a reduced risk of new-onset type 2 diabetes among adults with prediabetes and heart failure or chronic kidney disease. These findings indicate the potential usefulness of SGLT2 inhibitors as a pharmaceutical approach to prevent diabetes in conjunction with lifestyle modification among high-risk adults with prediabetes.